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INSANITY AND INSANE ASYLUMS, f 

! 



REPORT OF E. T. WILKINS, M. D. 



COMMISSIONER IN LUNACY 



FOR THE 



STATE OF CALIFOKKIA, 



MADE TO 



HIS EXCELLENCY, H. H. MIGHT, GOVERNOR, 



December 2cL, 1871. 




SACEAMENTO: 
T. A. SPRINGER, STATE PRINTER. 

1872. 




/ 






F 



o 



1 Lull u. 






REPORT OF E. T. WELKINS, M. D., 

J 



FOE THE STATE OE CALIFORNIA, 



MADE TO 



HIS EXCELLENCY H. H. HAIGHT, GOVERNOR, 



December 2d, 1871. 



^ 



k 



^ 



£ 



25 SEP 1905 
D. ot'D. 



T. A. SPRINGER STATE PRINTER. 



*. . • 

• ♦ * 



> • «• • 









f 



Of 



CONTENTS 



CHAPTER I. 

INTRODUCTORY. 

Powers, Duties, and Appointment of Commissioner — Importance of the Commis- 
sion — Asylums Visited — Number of Patients in Asylums Visited — Other Insti- 
tutions Visited — Plans of Asylums — Statistical Tables — Meetings of Superintend- 
ents Attended — Importance of such Meetings — Books Obtained for the State 
Library — Sources of Information — Acknowledgments 1 

CHAPTER II. 

INSANITY A DISEASE OF THE BRAIN. 

"What is Insanity? 8 

CHAPTER III. 

INSANITY AS IT NOW EXISTS. 

The Subject Generally — Insanity in England — In Scotland — In Ireland — In Prance — 
In Italy — In Prussia — In Austria — In German States — In Bavaria — In Switzer- 
land — In Belgium — In Holland — In Denmark — In Sweden — In Norway — In New 
South Wales — In the United States — In California 8 



CHAPTER IV. 

CAUSES OF INSANITY — SOME OF THE INFLUENCES OPERATING IN ITS DEVELOPMENT. 

General Observations — Assigned Causes — Physical Causes — Moral Causes — Observa- 
tions upon Assigned Causes — Principal Assigned Causes — Insanity Pound in all 
Countries — Enumeration of the Insane — Tables Kelating to Enumeration — Enu- 
merations Imperfect — Difficulties in the way of a Perfect Enumeration — Influence 
of Age — Influence of Age in the Different Eaces — Influence of Sex — Influence 
of Marriage ~ 32 

CHAPTER V. 

INFLUENCE OF SOCIAL DISTINCTIONS. 

Diseases of the Brain Peculiar to no Class in Society 49 



IV 



CHAPTEE VI. 

APPARENT INCREASE OF INSANITY. 

Increase of Insanity Demonstrated 54 

CHAPTEE VII. 

INSANITY IN PRANCE. 

General Statistics of the Insane from 1854 to 1866 — Doctor Motet's Analysis of Le- 

goyt's Work 6Q 

CHAPTEE VIII. 

INSANITY AMONG THE ANCIENTS. 

In the time of the Ancients — In the Middle Ages — In the Eighteenth and Nine- 
teenth Centuries — In England — In France — In Rome — In the Germanic Con- 
federation — Observations upon Foregoing Subjects — Cruel Treatment the Result 
of Ignorance — New York Poor Houses — Amelioration in the Treatment of the 
Insane as compared with Former Periods — Proof of the Advantages of Moral 
Treatment 86 

CHAPTEE IX. 

INSANE ASYLUMS, LOCATION, SIZE, SITES, ETC. 

Location — Influence that Distance ought to have on Location — Effect of Multi- 
plying Hospitals — Effects of Railroads and other Facilities of Travel — Hospitals 
Better Known to Neighboring People — Observations on Foregoing Topics — New 
York State Lunatic Asylums — General Suggestions — Propositions relative to the 
Structure and Arrangements for American Institutions for the Insane — English 
Lunacy Commissioners on Sites, Construction, Size, etc. — Suggestions of the 
Scotch Board — Size of Hospitals — Quantity of Land Necessary — Comments upon 
Kirkbride's Views 108 

CHAPTEE X. 

INSANE ASYLUMS— DOCTOR MANNING'S REPORT. 

Synopsis of Doctor Manning's Report — Comments upon the same 144 

CHAPTEE XL 

CRIMINAL INSANE. 

An important question connected with the care of the insane should not be passed by 

without notice •• 161 

CHAPTEE XII. 

CHRONIC INSANE. 

Provisions for Curables and Incurables in Separate Institutions 164 



CHAPTEE XIII. 

TREATMENT 0E INSANITY. 

Treatment in English Asylums — Mania — Epilepsj 7 connected with Insanity — Paraly- 
sis connected with Insanity — Melancholia — Observations on present Treatment of 
Insanity 165 

CHAPTEE - XIY. 

INSANITY IN GENERAL. 

Increased attention to Insanity — Growth of Hospitals in United States — Increase of 
Hospitals in United States — Increased Accommodation — Hospitals exhibit Insan- 
ity — Non-residents — Should other States send their Insane to California — Insanity 
in other States — Results of Treatment — Curability of the Insane — Effects of Early 
Treatment — Good-Hospitals necessary to Favorable Results — Results in our Asy- 
lum — Doubtful and Hopeless Cases — Economy of Early Treatment — Probable 
Duration of Life in Chronic Cases — Increase of Patients in our Asylum — Causes 
tending to this Result — Will the Children of Foreigners be as Liable to Insanity 
as their Parents — Observations upon Physical and Moral Causes producing Insan- 
ity — Intemperance a Leading Cause of Insanity — Duty of State relative to Asy- 
lums — Physicians not generally Informed on the Subject of Insanity — Psychology 
recommended to be Taught in Medical Schools — Effect of the Liberal and of the . 
Economical Plan of Care and Treatment 188 

CHAPTEE XY. 

.ECONOMY 0E PROVIDING AMPLE CURATIVE ACCOMMODATIONS. 

The Economy of Restoration, and the Amount Saved the State by the Cures already 

Effected in our Asylum 218 

CHAPTEE XVI. 

PLAN BEST ADAPTED TO CARE AND TREATMENT OE THE INSANE. 

General Observations — Cottage System — Farm Asylums — Close Asylums — Pavilion 

Plan 222 

APPENDICES 231 



INDEX. 



Page. 

Asylums visited 2 

Acknowledgements 7 

Asylum at Stockton overcrowded 136 

Asylum at Stockton should be finished 137 

Asylums. New one needed 137 

Asylums. Results in California 194 

Asylums. Increase of patients in ten years 197 

Asylums. Duty of State 212 

Asylums. Manning's Report 144 

Attendants 187 

Asylums in process of erection 190 

Asylums. Good ones necessary to favorable results 194 

Asylums. Location, size, etc 108 

Asylums. Influence V)f distance 109 

Asylums in New York 117 

Asylums. Propositions relative to the structure 121 

Asylums. Best plan 222 

Asylums. Growth of. 189 

Asylums. Should be in healthy locality 138 

Asylums, Quantity of land necessary 138 

Asylums. Organization of 142 

Asylums. Increase of in the United States 191 

Asylums. Better known to the neighboring people 115 

Books obtained for State Library 6 

Cruel treatment the result of ignorance 100 

Concluding remarks 228 

Commissioners 138 

Comments on Kirkbride's views 144 

Construction 152 

Comments on Manning's Report 158 

Criminal insane 161 

Chronic insane. 164 

Curability of insane 202 

Dining halls 135 

Directors and Superintendents 186 

Doubtful and hopeless cases 195 



VI 11 



Duration of insanity 196 

Enumeration of the insane 40 

Enumeration. Difficulties of. 40 

Enumeration imperfect ' 40 

Effect of multiplying hospitals 112 

Effect of railroads 115 

English Lunacy Commissioners 124 

Economy of early treatment 195 

Effects of liberal treatment 215 

Economy of cure 218 

Establishment of asylums in the British Provinces 190 

General results 205 

Introductory I ' 1 

Importance of the Commission 1 

Insanity a disease of the brain 8 

Insanity as it now exists. 

Insanity 

Insanity 

Insanity 

Insanity 

Insanity 

Insanity 

Insanity 

Insanity 

Insanity 

Insanity 

Insanity 

Insanity 

.Insanity 

Insanity 

Insanity 

Insanity 

Insanity 

Insanity 

Insanity 

Insanity 

Insanity 



8 

9 

10 

12 

14 



in England , 

n Scotland 

in Ireland 

in Prance 

in Prance. Motet's Analysis 66 

in Italy 15 

in Prussia 16 

in Austria 17 

in the German States 19 

in Bavaria 20 

in Switzerland 21 

in Belgium 22 

in Holland 23 

in Denmark and Sweden .■ 25 

in Norway 26 

in New South Wales 27 

in the United States 28 

in California 30 

Causes and influences producing it 32 

Assigned causes 32 

Observations 34 

Insanity. Comparative view of assigned causes 36 

Influence of age 41 

Influence of sex 46 

Influence of marriage 47 

Influence of social distinction 49 

Insanity. Apparent increase of 54 

Insanity among the Ancients 86 

Insanity in the Middle Ages 93 

Insanity. Condition of in England 94 

Insanity. Condition of in Prance 97 

Insanity. Condition of in Kome and Limerick 97 

Insanity in the Germanic Confederation 98 

Insanity. Observations 99 

Insane in New York Poorhouses 100 



IX 

Insane. Amelioration In the treatment of insanity. Restraint and seclusion lOG 

Insane. One to four hundred and eighty-nine 13Q 

Increased mortality in Stockton 137 

Insanity. Treatment of. iq*, 

Insanity in general 188 

Insanity. Duration of the disease 193 

Information. Sources of 7 

APPENDICES. 

Appendix A — 

Statistical tables of United States 238 

List of Asylums in United States 234 

List of Asylums in Canada 246 

Appendix B — 

List of Asylums in England 247 

List of Asylums in Scotland 257 

List of Asylums in Ireland 262 

Appendix C — 

List of Asylums in Belgium 268 

List of Asylums in Holland 272 

List of Asylums in France 279 

List of Asylums in Italy 280 

List of Asylums in German States and Switzerland 282 

List of Asylums in Germanic Confederation 284 

Appendix G — 

Appendix G 289 

List of Asylums in France 291 

Appendix H — 

Opening of the Sussex Lunatic Asylum 294 

The Asylum Bootham, York 294 

Night Attendants 296 

York Asylum 298 

Missing List 299 

Brookwood Asylum 299 

Complaint and Commitment 303 

Physician's Certificate 303 

Dietary 305 

Richmond, near Dublin 305 

Sussex County Asylum. Diet scale 306 

Edinburgh Royal Asylum. Diet table 307 

Quartres Mares, near Rouen 308 

General Rules for the Surrey County Lunatic Asylums 309 

Proposed Case Book. (English History) 318 

State on admission more fully arranged 318 

Plans, etc., of the Boston Hospital for the Insane, at "Winthrop 339 

County of Surrey Additional Lunatic Asylum 342 



INSA^ITl 7 



T 



AND 



INSANE ASYLUMS. 



CHAPTEK I. 
INTKODUCTOKY. 



Powers, Duties, and Appointment of Commissioner — Importance of the Commission — 
Asylums Visited — Number of Patients in Asylums Visited — Other Institutions Vis- 
ited — Plans of Asylums — Statistical Tables — Meetings of. Superintendents Attended — 
Importance of such Meetings — Books Obtained for the State Library — Sources of 
Information — Acknowledgments. 

POWERS, DUTIES, AND APPOINTMENT OF COMMISSIONER. 

An Act authorizing the appointment of a Commissioner to visit the* 
principal Insane Asylums of the United States and Europe, approved 
February eighteenth, eighteen hundred and seventy, directs the Com- 
missioner to visit such asylums as soon as possible, and to collect and 
compile all accessible and reliable information as to their management, 
the different modes of treatment, and the statistics of insanity, especial 
attention being called to the asylums of Great Britain, Ireland, France, 
and Germany. He is further directed to make a written report to the 
Governor, in which he shall embody at length a history of the manage- 
ment adopted at such asylums, a statement of the different modes of 
treatment in use, and such statistics as he may deem reliable. 

The Governor conferred the honor of this appointment upon me, and 
being in entire accord with my tastes and desires, having for a long 
time felt a deep interest in the subject to be investigated and an earnest 
sympathy for that class of our fellow beings in whose behalf the inves- 
tigation was ordered to be made, I entered at once upon the duties 
assigned me. 

IMPORTANCE OP THE WORK. 

Appreciating the importance of the subject, and feeling that the peo- 
ple, and especially those whose duty it is to make our laws, protect our 



citizens, and provide for the care and maintenance of our unfortunates, 
should have all the light that the wisdom and experience of the learned 
men in other States and countries could shed upon a subject about which 
so little is known by the great mass even of the reading public, the work 
was entered upon with some misgivings, but a sincere hope that the 
laudable object of the mission might be crowned with success. 

The law is a comprehensive one, and opens a wide field for interesting 
investigation and extensive research; one in which many an eminent 
man has spent a lifetime of labor and of thought, which it has been our 
object to search for, to find, and to appropriate. 

We have not gone forth with the expectation or even the hope of 
originating anything upon the subject, but rather to collect the accumu- 
lated truths gathered by the wisdom and experience of other men in 
other lands, that we might bring them home to California and strew 
them broadcast before our people. We did not for a moment suppose 
that a tithe of this information could be embodied in a report, however 
elaborate. The diversity of subjects necessarily touched upon would 
render it impossible to enter fully into the consideration of any; yet it 
is hoped that the attention of those who desire further light on a matter 
of so much interest to the State, the citizen, and the philanthropist may 
be directed to the channel where it exists in abundance, and where it 
may be found by a little patient and careful research. To all such, 
therefore, who can find in the accompanying report only a fragment of 
what they desire to know, let us say, look to the shelves of our State 
Library, recently replenished with a liberal list of the most valuable 
works ever contributed by the mind of man to the science of psychol- 
ogy, and you will find nearly all that exists on the important subject to 
which we desire to attract your especial attention. 

Having spent a sufficient length of time at Stockton to become thor- 
oughly informed with regard to the condition, construction, and require- 
ments of our asylum, its general management, good features, and glaring 
defects, we started out to compare them with what could be found in 
other States and countries. These comparisons have in some respects 
been in our favor, and, as might naturally -be expected, against us in 
others — in what particulars we will endeavor to point out in due time, 
and trust, while we commend our virtues to our brethren for their adop- 
tion, we will with equal alacrity and liberality give up our defects and 
substitute them with some of the excellent features of other institu- 
tions. 

ASYLUMS VISITED. 

During these investigations, one hundred and forty-nine Insane Asy- 
lums in complete working order have been visited, making an average 
of two each week during the whole period. Forty-five of these were 
in the United States, one in Canada, fifteen in Italy, three in Bavaria, 
seven in Austria, eleven in the German States, two in Switzerland, thir- 
teen in France, eight in Belgium, three in Holland, twenty-four in Eng- 
land, ten in Scotland, and seven in Ireland, the names, locations, and 
names of the Superintendents of which will be found in the table fol- 
lowing: 



Name of Asylum. 




Name of Superintendent. 



United Statj:s: 

Insane Asylum of California , 

Alameda Park 

St. Vincent 

State Lunatic Asylum 

St. Louis County Asylum 

Eastern Asylum 

Western Asylum : 

Central Lunatic Asylum 

Maryland Hospital 

Mount Hope Retreat 

Eastern Lunatic Asylum 

Western Lunatic Asylum 

Tennessee Hospital 

North Carolina Insane Asylum 

South Carolina Insane Asylum 

Government Asylum 

State Lunatic Hospital 

Pennsylvania Hospital 

Insane Dep't Philadelphia Almshouse 
. Eiiends' Asylum 

State Lunatic Asylum 

State Lunatic Asylum 

Kings County Lunatic Asylum 

Bloomin gdale Asylum .' 

New i'ork City Lunatic Asylum 

Willard Asylum 

BrighamHall 

State Criminal Asylum 

General Hospital for the Insane 

Retreat for the Insane 

Vermont Asylum for the Insane 

Maine Insane Hospital 

New Hampshire Asylum for the In- 
sane , 

Butler Hospital for the Insane 

State Lunatic Hospital 

State Lunatic Hospital 

State Lunatic Hospital 

McLean Asylum lor the Insane 

Boston Lunatic Asylum 

Michigan Asylum 

Iowa Hospital for the Insane 

Illinois State Hospital for the Insane. 

Indiana Hospital for the Insane 

Longview Asylum 

Southern Ohio Lunatic Asylum 



Canada: 

Provincial Lunatic Asvlum 



Italy : 

Provincial Lunatic Asylum 

Capo di Chino Asylum (private) 

Morotrofio 

Santa Maria di Pieta 

Santa Margherita 

Bonifazio (provincial Insane Asylum) 

Provincial Asylum , 

San Servalo 

St. John and St. Paul 

Senavra 

Insane Asylum 

Dufour , 

Colombo 

Rossi Asylum 

Presso San Celso 



Stockton, California 

Alameda, California 

St. Louis, Missouri 

Pulton, Missouri 

Near St. Louis, Mo 

Williamsburg, Va 

Staunton, Va 

Near Richmond, Va 

Baltimore, Maiyland ... 

Near Baltimore 

Lexington, Kentucky... 

Hopkins ville, Ky 

Near Nashville 

Raleigh 

Columbia 

Near Washington, D. C 

Harrisburg, Pa 

Philadelphia, Pa 

Philadelphia. Pa 

Philadelphia, Pa 

Trenton, ]Sew Jersey ... 

Ltica, New York 

Platbush, Long Island.. 

Bloomingdale, N. Y 

Blackwetl's Island 

Ovid, N. Y 

Canandaigua, N. Y 

Auburn, N. Y 

Middletown, Conn 

Hartford, Conn 

Brattleboro ... 

Augusta 



G. A. Shurtleff. 
Euston Treanor. 



C. H. Hughes. 
Charles W. Stephens. 

D. R. Brower. 
P. T. Stribbling. 
D. B. Conrad. 
R, F. Steuart, 
William H. Stokes. 
John W. Whitney. 
James Rodman. 

J. H. Callender. 
Eugene Grissom. 
J. F. Ensor. 
Charles C. Nichols. 
John Curwen. 
Thomas G. Kirkbride. 
D. D. Richardson. 
J. H. Worthington. 
H. A. Buttolph. 
John P. Gray. 
Edw. R. Chapin. 
D. Tilden Brown. 
R. L. Parsons. 
J. B. Chapin. 
George Cook. 
James W. Wilkie. 
A. M. Shew. 
John S. Butler. 
William H. Rockwell. 
Henry M. Harlow. 



Concord ., James P. Bancroft. 

Providence, R. I John W. Sawyer. 

Worcester, Mass I Merrick Bernis. 

Northampton, Mass J Pliny Earle. 

Taunton, Mass j William W. Godding. 

Somerville, Mass i George P. Jelly. 

Boston, Mass j Clement A. Walker. 

Kalamazoo i E. H. Van Deusen. 

Mount Pleasant ' Mark Ranney. 

Jacksonville j Henry F. Carriel. 

Indianapolis | Orpheus Everts. 

Longview, Ohio 0. M. Langdon. 

Dayton, Ohio R. Gun dry. 



Toronto 



Joseph Workman. 



Genoa 

Naples I Dr. Avesa. 

Aversa •. Antonio Ratfo. 

Rome ; Joseph Girolami. 

Perugia [ Cav. Guiseppe Neri. 

Florence ] Dr. Cardini. (?) 

Bologna ' Fiances Foucarti. [rio. 

Venice ! P. Prosdocimo, D. Sale- 
Venice i Antonio Berti. 

Milan ; 



Mombello 

Milan 

Milan 

Milan 

Milan 



Rinaldo Gectano. 
F. Franceso Corbetta. 
Achille Colombo. 
Antonio J. Bonfanti. 
Serafino Biffi. 



Name of Asylum. 



Location. 



N ame of Superintendent. 



Bavaria: 
Royal District Asylum.... 
District Lunatic Asylum. 
District Lunatic Asylum , 



Austria: 

Tyrolese Provincial Asylum 

Institute for Care and Cure of the 
Insane 



Royal Institute for Care and Cure of 

Insane 

Private Insane Asylum 

Asylum for Chronic Insane 

District Lunatic Asylum 

Royal Bohemian Asylum 



Saxony and German States: 

Sonnenstein 

Private Asylum 

Asylum for Chronic Insane ... 

Charity Hospital 

District Lunatic Asylum 

District Lunatic Asylum 

Thonberg Asylum 

District Lunatic Asylum 

District Lunatic Asylum 

District Lunatic Asylum 

Illenau Asylum 



Switzerland: 
Public Asylum . 
Public Asylum . 



France : 
Department Asylum. 



Antiquaille ......... 

St. Jean de Dieu 



St. George 

Chartreuse Asylum. 



Asjdum for Insane of St. Yonne 
St. Anne 



La Saltpetriere 

Doctor Blanche's Asylum. 

National Asylum , 

Colony Fitz James 



Quatre-mares St. Yon 
St. Yon 



Belgium: 
Asylum of Ansard Glaine 

Liege Hospital 

Colon} 7 at Gheel 

Insane Asylum 

Guislain Asylum 

St. Joseph 

Sts. Julien and Michael 

Du Strop (private) 



Munich 

Irsee 

Diggendorf 



Hall 
Linz 



Vienna 

Dobling 

Klosterneuberg.... 
Brunn, Moravia... 
Prague, Bohemia. 
Sleep, Bohemia.... 



Sonnenstein, Saxony 

Pirna, Saxony 

Hubertusburg, Saxony. 

Berlin 

Neustadt, Prussia 

Halle 

Thonberg, near Leipsic. 

Gottingen- 

Frankfort 

Heppenheim 

Aciiern 



Zurich 

Waldau, near Berne. 



Stephansfeld (Strasb'g), 

Lyons 

L3^ons 



Bourg. 
Dijon . 



Auxerze 
Paris 



Paris 

Passy, Paris. 
Charenton.... 
Clermont 



Aug. Solbrig. 
J. M. Kiderle. 
Dr. Ast. 



Joseph Stolz. 

A. Knorlein, Director, 
Dr. Schasching, Phy'n. 

Dr. Spurzheim. 
Dr. Leiderdorf. 
Dr. Mildner. 
Dr. Langer. 
Dr. Fischel. 
Dr. Kratochril. 



H. Lessing. 
O. Lehman. 
George Ehrst. 
Dr. "Westphal. 
Dr. Sponholz. 
Dr. Koeppe. 
E. W. Guntz. 
Ludwig Meyer. 
H. Hoffman . 
Dr. Ludwig. 
C. Roller. 



D. Gudden. 

Dr. Fetscherin, Phy'n, 
Dr. Schaerer, Direct'r 

Dr. Hildebrand, Phy'n, 
R. du Matey, Director 

J. Arthaud, Director 
and Physician. 

Dr. Carrier, Physician, 
J. de Matha, Director. 



Rouen 
Rouen 



Dr. Bruno, Director and 

Physician. 
Dr. Ceilleux, Director 

and Physician in Chief 
M. Bayent, Director ; 

M. Dagonet, Phy'n. 
M. Phelip, Director. 
Dr. Blanche. 
Dr. Calmeil. 
Gustave Labitte, Phy'n, 

M. J. Labitte, Direct'r 
Dr. Ed. Dumesnil. 
Dr. Morel. 



Liege ! Dr. C. Anten. 

Liege . % 

Gheel Dr. Bulckens. 

Antwerp T. Targue. 

Ghent i B. Ingels. 

Ghent j Dr. Nermenten. 

Bruges Dr. Van den Abeele, 

Ghent i Dr. Nermenten. 



or 



Name of Asylum. 



Location. Name of Superintendent. 



Holland : 
ReinierVan Arkel Eois le Due 



Meerenberg Asylum. 
Citv Asylum 



England: 

Royal Infirmary 

County Lunatic Asylum. 

St. Luke's Madhouse 

Bethlem Hospital 

Grove Hall, Bow 

County Lunatic Asylum. 



Near Haarlam 
Rotterdam 



Liverpool 

Rainhill 

London 

London 

Bow, London. 
Han well 



County Lunatic Asylum Colney Hatch 



Surrey County Lunatic Asylvm 

Sussex County Lunatic Asylum 

Essex Lunatic Asylum 

Bristol Borough Asylum 

Glamorgan County Lunatic Asylum- 
County Lunatic Asylum 

Barnwood House 

Buckingham County Pauper Lunatic 
Asylum 

Borough Lunatic Asylum 

County of Warwick Pauper Lunatic 
Asylum 

Derbyshire County Pauper Lunatic 
Asylum 

West Riding Pauper Lunatic Asylum 

Friends' Retreat 

York Lunatic Asylum 

Newcastle-upon-Tyne Borough Lu- 
natic Asylum 

Cumberland and Westmoreland Lu- 
natic Asylum 

Littlemore Asylum 



Brookwood 

Hay ward s Heath 

Brentwood 

Stapleton 

Bridgend 

Wotten, n'r Gloucester. 
Gloucester 



T. Frybouh. (?) 
B. H." Everts. 
G. Yrolck. 



Dr. Stockwell. 

T. L. Rogers. 

Dr. Eager. 

AY. Rhys Williams. 

Dr. Stocker. 

W. C. Begley, Male 
Dep't; J. M. Lind- 
say, Female Dep't. 

Eagar Sheppard, Male 
Dep't; AY. G. Mar- 
shall, Female Dep't. 

Thomas N. Brushfield. 

S. AY. D. Williams. 

D. C. Campbell. 
G. Thompson. 
David Yellowlees. 

E. Toller. 
A. J. AYood. 



Scotland : 

Edinburgh Royal Asylum 

Saughton Hall (private) 

Fife and Kinross District Asylum 

The Colony of Kennoway 

Royal Asylum 

Hall Cross Asylum 

District Asylum 

District Asylum 

AYhite House Asylum (private) .... 



Stone-* ; John Humphrey. 

Birmingham j T.Green. 

Hatton, near Warwick.' W. H. Parsey. 

Mickleover | John Hitchman. 

Wakefield j J. Crichton Browne. 

Near York J. Kitching. 

York | F. Needham. 

Newcastle j R. H. B. Wickham. 

Near Carlisle ! T. S. Clouston. 

Littlemore, Oxford I R. H. H. Sankey. 



Mornin erside ' David Skae. 



Near Edinburgh 

Near Cupar, Co. Fife... 

Kennoway 

Dundee 

Musselburgh 

Inverness 

Stirling 

Musselburgh 



Dr. Low. 
John B. Tuke. 



James Rorie. 



Royal Asylum 
Royal Asylum 



Ireland : 

District Asylum 

Richmond District Asylum, 
Bloomlield Retreat 



Thomas Aitken. 

F. W. A. Skae. 

Mrs. Thompson, Sup't; 
Dr. Thompson, Phy'n 

Glasgow j Alexander Mackintosh. 

Perth ; Lander Lindsay. 



Maryborough District Asylum. 



Belfast 

Dublin 

County Dublin 



Maryborough 



Robert Stewart. 

Joseph Lai or. 

H. A. Lodge, Sup't Male 
Dep't; Alarv Prvor, 
Female Dep't; J. H. 
Wharton, Physician. 

J. H. Hate-hell. 



Cork District Lunatic Asylum Cork Thomas Power. 



Killarney Asylum Killarney 

Central Asylum for Criminal Luna- 
tics Dundrum 



W. AY . Murphy. 



NUMBER OF PATIENTS IN ASYLUMS VISITED. 

The number of patients treated in these asylums during the last year 
was seventy-six thousand six hundred and seven, or an average of five 
hundred and fourteen for each institution. In addition to the asylums 
mentioned, a number of asylums in process of erection, lunatic wards of 
Poor Houses, Idiot and Deaf and Dumb Asylums, ordinary hospitals, 
penitentiaries, and other governmental, State, county, and city estab- 
lishments have been visited and examined, and such features noted as 
appeared might at any time be of interest or importance to the State. 

PLANS OF ASYLUMS. 

A large number of plans of asylums, rules, regulations, etc., have 
been procured, a portion of which will be found in the appendix, and 
all are at the service of the State. 

STATISTICAL TABLES. 

The statistical tables have cost much time and patient labor, and are 
believed to be as complete as any ever published on this subject, and 
the facts set forth in them have been gathered from the latest and most 
reliable sources known to exist. 

MEETINGS OF SUPERINTENDENTS ATTENDED. 

It has been our good fortune to have attended the meeting of the 
Superintendents of American Institutions for the Insane at Hartford 
last year, and those of a similar character for France, in Paris, and of 
Great Britain, in London during the present year. It is needless to 
dilate upon the high character and intellectual capacity that distinguish 
the men who compose these associations, nor upon the great service 
they have rendered to humanity by sending forth the results of their 
individual and collective experiences to enlighten mankind and relieve 
the distresses of their fellow men. They are the rays of light that 
dispel the mists and drive away the thick clouds by which the mind of 
man is enveloped when the brain is diseased. " Their's, indeed, is a mis- 
sion of mercy, and verily they shall reap their reward." 

IMPORTANCE OF SUCH MEETINGS. 

So important do these annual meetings appear to our mind we do not 
hesitate to express the opinion that it should be made the duty of 
the Superintendent of every asylum, or an assistant, to attend each 
meeting, feeling assured that the opportunity presented for an inter- 
change of opinions with those engaged in a like calling could not fail to 
be both agreeable and instructive to himself, but beneficial to those com- 
mitted to his care and the State in whose service he is engaged. We 
feel under especial obligations to them, and to all others who have con- 
tributed to our pleasure or added to our stock of information. 

BOOKS OBTAINED FOR STATE LIBRARY. 

A large number of books, reports, and essays on insanity and State 
medicine have been obtained for the State Library by purchase or dona- 



tion from various sources and countries, comprising in the list nearly all 
of the standard works of the most celebrated authors who have written 
upon the subject of insanity, and the most recent and reliable informa- 
tion on the statistics of lunacy that could be found. Among these are 
the works of Allen, Anderson, Arlidge, Bingham, Browne, Bucknill and 
Tuke, Burrows, Conolly, Crowther, Dunn, Ellis, Gall, Hill, Hills, Hoods, 
Jacobi, Morrison, Prichard, Seymour, Sieveking, Williams, Winslow, 
including Journal of Psychological Medicine, 1848 to 1863, and the more 
recent productions of Yan Der Kolk, Brown, Sankey, Mandsley, Blan- 
ford, Fry, Casper, Griesinger, Davis; translation of Pmel, Cox, Liddell; 
translation of Esquirol, Mayo, and a set of the Journal of Mental Science 
from commencement of volume two to the present time. Also, very 
nearly a complete set of the Reports of the Commissioners in Lunacy, 
and other valuable documents presented by Mr. Wilkes, one of the Com- 
missioners; a j)artial set of the Reports of the Scotch Commissioners, 
and other documents presented by Sir James Cox and Dr. Sibbald, of 
that Board; the last Report of the Commissioners for Ireland; special 
reports of all the asylums visited, where these were published and attain- 
able; essays on a variety of subjects; rules and regulations of asylums, 
general and special; descriptions of asylums by sundry persons; reports 
of Special Commissioners, and many other documents of more or less 
interest. Among the French works will be found those of Foville, Dag- 
onet, Calmiel, Faivet, Morel, Mundy, Motet, and others. From Prussia, 
a volume of general statistics for eighteen hundred and sixty-seven; a 
valuable treatise on construction and plans of asylums for the insane, 
containing the opinions of many of the most eminent psychologists of 
that country, and a brief account of all the asylums of the German 
Confederation in eighteen hundred and sixty-five, by Dr. H. Laeur, 
together with a few other documents of minor importance. Besides the 
reports, more or less complete, of all the asylums visited in the United 
States, a variety of documents, including statistics of the insane and 
idiotic for eighteen hundred and seventy, essays, lectures; reports of 
Commissioners sent into other States and countries, and those of a local 
character; reports of Boards of Charity of New York, Massachusetts, 
Ohio, and Pennsylvania, of the Cities of New York and Boston, and a 
number of other documents of interest and importance, and from most 
countries plans of asylums, more or less complete, of some of the best 
institutions known to exist, embracing every variety, from the palatial 
hospital to the modest cottage. 

The professional man will find much that is trite and familiar in this 
report, but it must not be forgotten that it is not so much for him as for 
the public that it has been prepared. 

SOURCES OF INFORMATION. 

The information which it contains has been derived from various 
sources. The work of other men's brains has been freely appropriated. 
Their experiences we have endeavored to use to the best advantage; and 
even the errors committed by some of them have taught us valuable 
lessons, as it is sometimes as necessary to know what to avoid as what 
to adopt. 

ACKNOWLEDGMENTS. 

Much has also been learned from personal intercourse with men of 
ability in all the countries we have visited, and we can never forget nor 



8 

ever cease to be grateful for the many acts of courtesy, kindness, and 
attention that we have received at their hands. To Drs. Shurtleff, Strib- 
bling, Kirkbride, Gray, Buttolph, and Walkar, in each of whose estab- 
lishments we spent several days in the early part of our investigations, 
we are especially indebted for the kind manner in which they took us 
by the hand and started us "right foot foremost" in the path of our 
duty. Nor have we forgotten the attentions and courtesies of a single 
Superintendent whose asylum we visited in America or Europe. 



CHAPTER II. 

INSANITY A DISEASE OF THE BKAIN. 

What is insanity? This question has been often asked, but perhaps 
has never been satisfactorily answered, for the simple reason that 
insanity assumes so many forms and differs so widely in different per- 
sons that no definition can possibly embrace all of its phases. Many 
persons have given definitions of this subtle malady, but not one has 
met with that universal concurrence necessary to render it the true and 
only or even the generally received definition. We do not propose to 
enter this list, but as much must be said on the subject in the following 
pages it is best, perhaps, that a selection should be made. 

In a lecture delivered before the Eoyal College of Surgeons, March 
first, eighteen hundred and sixty-one, by David Skae, M. D., F. E. C. S., 
Physician to the Eoyal Edinburgh Asylum, he defined it to be " a disease 
of the brain affecting the mind." We accept this definition as the best 
of all, because it is the most simple. It makes but little difference how 
the brain becomes diseased, whether primarily or by reflex action from 
the disease of some other organ of the body, so the fact as stated be 
true that the brain must be diseased ere the mind is affected. 



CHAPTEE III. 

INSANITY AS IT NOW EXISTS. 

The Subject Generally — Insanity in England — In Scotland — In Ireland — In France — In 
Italy — In Prussia — In Austria — In German States — In Bavaria — In Switzerland — In 
Belgium — In Holland — In Denmark — In Sweden — In Norway — In New South Wales 
— In the United States — In California. 

THE SUBJECT GENERALLY. 

In considering the subject of insanity, it is proper first to inquire to 
what extent it exists in the world and in our midst. To do this we have 
prepared tables exhibiting the population of various countries, divided 
into self supporting and pauper classes (where these have been sepa- 
rated), and in all cases the total population, number, and distribution of 
the insane at the latest dates at which these facts could be obtained; 
the proportion of the insane to population, the ratio per thousand, the 
proportion of pauper insane to pauper population, the proportion of 



insane under treatment to population, the number in hospitals and asy- 
lums at latest date; numbers admitted, cured, died, and treated during 
the year; the number of asylums in each country; the principal assigned 
causes of the disorder and of death; together with the numbers resident 
at beginning of the year; numbers admitted, cured, and died during the 
year, and the percentage of recoveries and of deaths to admissions and 
to numbers treated in the asylums visited in different countries; to 
which we have added similar facts for Norway, Sweden, and the Colony 
of JS~ew South Wales. 

INSANITY IN ENGLAND. 

Population, 1870. 



Self supporting classes 
Paupers 

Total population.., 



21,006.631 
1,083^532 

22,090,163 



dumber and Distribution of the Insane, January 1st, 1870. 



Private. Pauper. 



County and Borough Asylums 

Registered Hospitals 

Metropolitan Licensed Houses , 

Provincial Licensed Houses 

jSaval and Military Hospitals and Royal India 

A sy lum 

Workhouses 

With relatives or others '. 

Broadmoor Criminal Asylum 



Totals 



259 
1,969 
1,666 
1,478 

198 



356 
354 



6,280 



27,721 

400 

1.034 

726 



11,358 

7,086 
108 



48,433 



Totals. 



27,980 
2,369 
2.700 
2^204 

198 

11,358 

7,442 

462 

54,713 



Proportion of insane to population, one in four hundred and three; or, 
ratio per one thousand, two and forty-seven one hundredths. Propor- 
tion of pauper insane to pauper population, one in twenty-two; or, ratio 
per one thousand, forty -four and sixty-nine one hundredths. Proportion 
of insane (under treatment) to population, one in six hundred and fifteen; 
or, ratio per one thousand, one and sixty-two one hundredths. 



The number of Insane in Hospitals, Asylums, and Licensed 

Houses, January 1st, 1870 35,913 

Admitted during the year 11,462 

Cured 3^955 

Died 3,790 

Number treated in 1870 47,375 



10 



Per cent of recoveries on admissions 34 

Per cent of recoveries on number treated 8 

Per cent of deaths on admissions j 33 

Per cent of deaths on number treated i 8 



Number of Asylums, etc., for the Insane in England and Wales. 



County and Borough Asylums 

Registered Hospitals 

State A sylums 

Metropolitan Licensed Houses 

Provincial Licensed Houses 

Total number of Institutes for the Insane 



50 
16 
4 
41 
65 

176 



The average weekly cost per head in County Asylums is nine shillings 
five and one eighth pence, or two dollars and twenty-eight cents. 

The principal assigned causes of insanity are: hereditary, intemper- 
ance, domestic trouble, epilepsy, mental anxiety, puerperal condition and 
critical period, paralysis. 

The principal causes of death are: general paralysis, diseases of the 
lungs, diseases of the brain, epilepsy, debility and old age, apoplexy. 



In twenty asylums visited in 1870, the number of patients resi- 
dent was 

Admitted 

dumber treated 

Cured 

Died 



12,116 

. 3,670 

15,786 

1,369 

1,220 



Per cent of cures on admissions 

Per cent of cures on number treated.. 

Per cent of deaths on admissions 

Per cent of deaths on number treated. 



37 

8 

33 

7 



INSANITY IN SCOTLAND. 

Population, January 1st, 1870. 



Self supporting classes 

Paupers (May 14th, 1869) 

Total population 



3,142,503 

80,334 

3,222,837 



11 



Number and Distribution of the Insane. 





Private. 


Pauper. 


Totals. 


In Poyal and District Asylums 


914 

249 


3,547 

54 

553 

574 

49 

30 

1,469 


4,461 


In Private Asylums 


303 


In Parochial Asylums 


553 


In Lunatic Wards of Poorhouses 




574 


In General Prison 




49 


In Training" Schools for Imbeciles 


83 
49 

1,295 


113 


In Private Dwellings 


1,518 






Totals, January 1st, 1870 


6,276 


7,571 







Besides the number of insane given above, it is estimated that there 
are about two thousand unreported, making the total number nine thou- 
sand five hundred and seventy-one. 

Proportion to the population, one in three hundred and thirty-six; or, 
ratio per one thousand, two and ninety-six one hundredths. Proportion 
of insane (under treatment) to population, one in six hundred and six; 
or, ratio per thousand, one and sixty-four one hundredths. Proportion 
of pauper insane to pauper population, one in thirteen; or, ratio per one 
thousand, seventy-eight and twelve one hundredths. 



Number of insane in asylums, January 1st, 1870. 

Admitted during the year 

Cured 

Died 

JST umber treated in 1870 ". 



5,317 

2,015 

832 

491 

7,332 



Per cent of recoveries to admissions 

Per cent of recoveries to number treated. 

Per cent of deaths to admissions 

Per cent of deaths to number treated 



41 
11 
24 

7 



Number of Institutions for the Insane. 



District Asylums 

Poyal Asylums 

Private Asylums 

Parochial Asylums 

Total Asylums 

Lunatic Wards of Poorhouses 

Total 



10 
7 
9 
5 



31 
15 

46 



12 

The average weekly cost of maintenance of pauper lunatics in Royal 
and District Asylums is nine shillings and nine and one fourth pence; in 
Private Asylums, ten shillings and two and a half pence; in Parochial 
Asylums, eight shillings and five and a half pence; making a general 
average cost of nine shillings and five and three fourths pence, or two 
dollars and twenty -nine cents. 

The principal assigned causes of insanity are: climacteric changes, old 
age, intemperance, child bearing. # 

The principal causes of death are: consumption, general debility and 
old age, organic disease of brain, inflammation of lungs, general" paral- 
ysis. 



In six asylums visited in 1870, the number of patients resident 

was : 

Admitted. . . . 

Treated 

Cured 

Died 



1,995 

1,030 

3,025 

365 

206 



Per cent of cures on admissions 

Per cent of cures on number treated.. 

Per cent of deaths on admissions 

Per cent of deaths on number treated. 



35 

12 

20 

6 



INSANITY IN IRELAND. 

Population, 1870. 

Total population 5,195,236 

Number and Distribution of the Insane, December 31st, 1870. 





Private. 


Pauper. 


Totals. 


In District A sylums 


122 

638 


6,533 


6,655 


In Private Asylums 


638 


In Jail 


1 

2,754 

43 

167 


1 


In Workhouses 




2,754 


In Lucan 




43 


In Central ' 




167 


Lunatics at large 


6,936 
7,696 


6,936 








Totals 


9,498 


17,194 







Proportion of insane to population, one in three hundred and two; or, 
ratio per one thousand, three and thirty one hundredths. Proportion of 



13 

insane (under treatment) to population, one in seven hundred and twenty- 
nine j or, ratio per one thousand, one and thirty-seven one hundredths. 



JSTumber of insane in asylums, January 1st, 1870 7,121 

Admitted during the year 2,532 

Cured 1.088 

Died 708 

dumber treated in 1870 9,653 



Per cent of recoveries on admissions 

Per cent of recoveries on number treated. 

Per cent of deaths on admissions 

Per cent of deaths on number treated 



43 
11 

27 
7 



Number of Establishments for the Insane. 



District Asylums 23 

Private Licensed Houses 20 

Asylums for Criminals ■ 1 

Total '' 44 



t The average weekly cost per head in District Asylums is eight shill- 
ings and eleven and a half pence, or two dollars and seventeen cents. 

The principal assigned causers of insanity are: hereditary, grief, fear 
and anxiety, intemperance and irregularity of living, disease of the 
brain, bodily injuries and disorders. 

The principal causes of death are: thoracic disease, cerebral disease, 
debility, and old age. 



In eleven asylums visited in 1870, the number of patients resi- 
dent was •. 2,437 



Admitted. 
Treated . , 

Cured , 

Died 



1.206 

3^643 

457 

256 



Per cent of cures on admissions 

Per cent of cures on number treated.., 

Per cent of deaths on admissions 

Per cent of deaths on number treated. 



37 

12 
21 

7 



14 

INSANITY IN FRANCE. 

Population, 1866 37,988,90.5 

Number and Distributio?i of the Insane, 1866. 



Insane. 



Idiots. 



Totals. 



In asylums 
At home 

Totals 



31,992 
18,734 

50,726 



3,980 
35,973 

39,953 



35,972 
54,707 



90,679 



Males. 



Females. 



Totals. 



Insane 
Idiots.. 



24,190 
22,736 



26,537 
17,217 



50,726 
39,953 



Proportion of insane to population, one in seven hundred and forty- 
seven; or, ratio per one thousand, one and thirty -three one hundredths. 
Proportion of idiots to population, one in nine hundred and fifty. Pro- 
portion of insane and idiots to population, one in four hundred and 
eighteen; or, ratio per one thousand, two and thirty-eight one hun- 
dredths. Proportion of insane and idiots (under treatment) to popula- 
tion, one in one thousand and fifty-seven; or, ratio per one thousand, 
ninety-four one hundredths. 

Population, 1860 37,170,942 



Number of insane in hospitals and asylums, January 1st, 1860. 

Admitted during the year 

Cured or improved 

Died 



Number treated in 1860. 



28,761 

10,786 

4,337 

4.970 

39^546 



Per cent of recoveries on admissions 

Per cent of recoveries on number treated. 

Per cent of deaths on admissions 

Per cent of deaths on number treated 



40 
11 
46 
12 



Number of Asylums for the Insane in eighteen hundred and sixty 
(public and private establishments), ninety-nine. 

In eighteen hundred and fifty-three, the average weekly cost per 
head was one dollar and twenty-one cents. 



15 

The principal assigned causes of insanity, as per reports eighteen hun- 
dred and fifty-three, were: hereditary, epilepsy and convulsions, intem- 
perance, destitution and misery, loss of fortune. 

The principal causes of death: paralysis, disease of brain, pneumonia, 
insanity, brain fever. 



In thirteen asylums visited in 1870, the number of patients 

resident was 

Admitted (in eleven of these) 

* Cured (in eleven of these) 

Died (in eleven of these) 

Number treated (in eleven of these) 



7,938 

3,324 

873 

1,292 

11,262 



Per cent of recoveries on admissions 

Per cent of recoveries on number treated. 

Per cent of deaths on admissions 

Per cent of deaths on number treated 



26 

7 

38 

11 



INSANITY IN ITALY. 

Population, 1864 22,291,181 

Ev the addition of Yenice, in 1866, the population was increased to 
24,263,320. 

Number of insane in asylums, January 1st, 1867 8,191 

Proportion of insane (under treatment) to population, one in two 
thousand nine hundred and sixty-two; or, ratio per one thousand, thirty- 
three one hundredths. • 



Number in asylums, January 1st, 1867. 
Admitted 



Discharged 
Died 



Number treated during the year 

Number remaining January 1st, 1868. 



8,191 
4,909 
3,210 
1,504 
13,100 
8,386 



Per cent of discharges on admissions 

Per cent of discharges on number treated 

Per cent of deaths on admissions , 

Per cent of deaths on number treated 



65 
24 
30 
11 



* Leaving out the Asylum. La Salpetriere (for chronic cases only), the per cent of cures 
on admissions would be twenty-seven. 



16 
Fifteen asylums were visited in eighteen hundred and seventy. 



In fourteen of these the number resident was 

In thirteen of these the admissions were 

In twelve of these the number treated was.... 
In thirteen of these the number cured was.... 
In thirteen of these the number died was 



4,259 

1,967 

5,316 

764 

621 



Per cent of recoveries on admissions l 38 

Per cent of recoveries on number treated '• 13 

Per cent of deaths on admissions | 31 

Per cent of deaths on number treated I 10 



The average weekly cost of maintenance of indigents in eight public 
asylums is one dollar and seventy-seven cents. 

Principal causes of death: disease of the lungs, paralysis, marasmus. 

Principal assigned causes of insanity: pillagra, hereditary, intemper- 
ance. 



INSANITY IN PRUSSIA. 

Population, 1864 19,252,363 

Number of Insane Under Treatment. 



In Public Asylums . 
In Private Asylums 

Total 



4,796 
944 

5,740 



Proportion of insane (under treatment) to population, one in three 
thousand three hundred and 'fifty-four; or, ratio per one thousand, 
twenty-nine one hundredths. 

Number of Asylums. 



Public Asylums.. 
Private Asylums 

Total 



32 

27 

59 



Expenses of Public Asylums, six hundred and fourteen thousand six 
hundred and sixty-four thalers, or four hundred and forty-eight thou- 
sand seven hundred and four dollars and seventy-two cents, which gives 
a weekly cost per head of one dollar and eighty cents. 



17 



In two asylums visited in 1870, the number of patients resident 

was 

Admitted 

Cured 



Died 

Number treated 



1,065 

297 

105 

110 

1,362 



Per cent of cures on admissions 

Per cent of cures on number treated.. 

Per cent of deaths on admissions 

Per cent of deaths on number treated 



35 

7 

37 

8 



The average weekly cost of maintenance of indigents in these two 
asylums is one dollar and ninety-five cents. 

Principal assigned causes of insanity: The Director at Halle says that 
eighty per cent of cases of insanity are from hereditary causes. 

Principal causes of death: general paralysis, epilepsy. 

Population, December, 1867 23,971,337 



The total number of insane. 
The total number of idiots . 



Total number of unsound mind. 



16,929 
21,031 

37,960 



Proportion of insane and idiots to population, one in six hundred 
and thirty-one, or ratio per one thousand 

Proportion of insane to population, one in fourteen hundred and 
sixteen, or ratio per one thousand. 



1.58 
.70 



INSANITY IN AUSTRIA. 

German Austria, exclusive of Hungary. 

Population, 1864 13,000,000 

Number of Insane in Asylums. 



In Public Asylums . 
In Private Asylums 

Total 



3,065 
150 

3,215 



18 



Proportion of insane (under treatment) to population, one in four 
thousand and forty-three, or ratio per one thousand 



.24 



Number of Asylums. 



Public Asylums.. 
Private Asylums. 

Total 



14 
4 

18 



Expenses of Public Asylums, eight hundred and seventy -three thou- 
sand seven hundred and fifty-six florins, or four hundred and twenty- 
two thousand eight hundred and ninety-seven dollars and ninety cents, 
which gives an average weekly cost per head of two dollars and sixty - 
five cents. 



In six asylums visited in 1870, the number of patients resident 

was 

Admitted 

Cured 

Died 

Number treated 



2,302 

1,741 

377 

543- 

4,043 



Per cent of cures on admissions 

Per cent of cures on number treated.. 

Per cent of deaths on admissions 

Per cent of deaths on number treated. 



21 

9 

31 

13 



The new asylum, Klosterneuberg, was also visited. It was opened in 
eighteen hundred and seventy, so there was no report for the year. The 
number resident was one hundred and twenty-three. 

The average weekly cost of maintenance of indigents in the Public 
Asylums visited was two dollars and thirty -nine cents. 

The Statistical Bureau give's three hundred and ninety-seven thousand 
and ninety dollars as the cost of supporting four thousand four hundred 
and ninety -nine pauper patients in eighteen hundred and sixty-nine — 



An annual cost per head of. 
A weekly cost per head of.. 



$88 26 
1 70 



The principal assigned causes of insanity: inherited or congenital 
tendency, affliction, poverty, remorse, intemperance. 

The principal causes of death: disease of the lungs, paralysis of the 
brain, marasmus. 



19 

INSANITY IN THE GERMAN STATES. 

Population, 1864 13,747,637 

Number of Insane in Asylums and Hospitals. 



In Public Asylums... 
In Private Asylums. 



Total 



9,962 
633 

10,595 



Proportion of insane (under treatment) to population, one in twelve 
hundred and ninety-seven, or ratio per one thousand 



.77 



Number of Asylums. 



Public Asylums... 
Private Asylums. 



Total. 



46 
18 

64 



In ten asylums visited in 1870, the number of patients resident 

was , 

Admitted 

Cured 



Died 

Number treated. 



2,495 

1,046 

276 

290 

3,541 



Per cent of cures on admissions 

Per cent of cures on number treated.. 

Per cent of deaths on admissions 

Per cent of deaths on number treated. 



26 

7 

27 

8 



At Illenau the numbers for ten years were obtained. They were as 
follows: 



Admissions 

Cures 

Deaths 

Number treated. 



4,086 

1,570 

597 

4,512 



20 



Per cent of cures on admissions 

Per cent of cures on number treated .. 

Per cent of deaths on admissions 

Per cent of deaths on number treated 



38 
34 
14 
13 



The average weekly cost of maintenance for indigents in the Public 
Asylums visited was one dollar and sixty cents. 



INSANITY IN BAVARIA. 

Population, 1864 4,807,440 

Number of Insane Under Treatment. 



In Public Asylums.. 
In Private Asylums. 



Total 



1,831 
19 

1,850 



Proportion of insane (under treatment) to population, one in two 
thousand five hundred and ninety-eight, or ratio per one thou- 
sand 



.38 



Number of Asylums. 



Public Asylums.. 
Private Asylums. 



Total. 



9 
2 

11 



In 1861 the population was 

The total number of insane 

Proportion to population, one in nine hundred and fifty-seven, 
or ratio per one thousand 



4,689,837 
4,899 

1.04 



In the six District Lunatic Asylums the number of patients Octo- 
ber 1st, 1865, was 

Admitted during the year 

Cured 



Died 

Number treated in 1865-6 .... 



1,651 
529 
171 
150 

2,180 



21 



Per cent of recoveries on admissions 

Per cent of recoveries on number treated. 

Per cent of deaths on admissions 

Per cent of deaths on number treated 



32 

7 

28 

6 



The average weekly cost of maintenance per head in the above Dis- 
trict Asylums was, in 1865-6, two dollars and fifty-three cents. 

Causes of insanity not specified; but in about twenty -nine per cent of 
the whole number of cases the insanity was hereditary. 

The principal causes of death: consumption, general paralysis, pleurisy 
and pneumonia, marasmus. 



In three asylums visited in 1870, the number of patients resident 
was 


658 


A dmitted 


324 


Cured 


112 


Died 


57 




982 


• 







Per cent of recoveries on admissions 

Per cent of recoveries on number treated. 

Per cent of deaths on admissions 

Per cent of deaths on number treated 



34 

11 

17 

5 



INSANITY IN SWITZERLAND. 

Population, 1860 2,510,494 



In two asylums visited in 1870, the number of patients resident 
was 



462 



The report for the asylum at Waldau is as follows; 



Number resident. 

Admitted 

Cured 

Died 

Number treated.. 



295 
83 
32 
19 

378 



22 



Per cent of cures on admissions 

Per cent of cures on number treated. 

Per cent of deaths on admissions 

Per cent of deaths on number treated 



38 
8 

22 
5 



Average weekly cost of maintenance of indigents is one dollar and 
sixteen cents. 



INSANITY IN BELGIUM. 

Population, 1865 4,984,451 

Number and Distribution of the Insane, December 31st 7 1865. 





Private. 


Pauper. 


Totals. 


In hospitals and asylums % 


1,579 
2,000 
3,579 


3,852 


5,431 


Estimated number at large who are supported by 
their families 












Totals 


3,852 


7,431 







Proportion of insane to population, one in six hundred and seventy 
one, or ratio per one thousand 

Proportion of insane (under treatment) to population, one in nine 
hundred and seventeen, or ratio per one thousand 



1.49 
1.09 



Number of insane under treatment in hospitals, January 1st, 1865. 

Admitted during the year 

Cured 



Died 

Number treated in 1865. 



5,441 

1,851 
642 
595 

7,292 



Per cent of recoveries on admissions 

Per cent of recoveries on number treated. 

Per cent of deaths on admissions •. 

Per cent of deaths on number treated 



34 

8 

32 

8 



23 



Number of Asylums for the Insane, 1865. 



For male patients only .. 
For female patients only 
For both sexes 

Total 



17 
17 
17 

51 



Twenty-seven of these asylums are for private patients and paupers; 
sixteen are for private patients only, and eight for paupers only. 

The average weekly cost of pauper patients varies from five francs 
and four centimes to ten francs and fifty centimes, or from ninety-five 
cents to two dollars. 

The fifty-one asylums of Belgium have a total capacity of five thou- 
sand three hundred and eighty-seven patients. 

The principal assigned causes of insanity are: poverty, losses, etc., 
intemperance, domestic trouble, disappointment. 

The principal causes of death are: cerebral marasmus, general paral- 
ysis, consumption, chronic bronchitis. 



In eight asylums visited in 1870, the number of patients resident 

was f 

Admitted into five of these asylums 

Treated in five of these asylums 

Cured in five of these asylums 

Died in five of these asylums 



3,029 
769 

3,567 
232 
311 



Per cent of recoveries on admissions 

Per cent of recoveries on number treated. 

Per cent of deaths on admissions 

Per cent of deaths on number treated 



30 

8 

40 

8 



INSANITY IN HOLLAND. 



Population, 1868 3,592,415 



Number of patients in Lunatic Hospitals, January 1st, 1868. 

Admitted 

Cured 



Died 

Number treated in 1868. 



3,179 
994 
380 
358 

4,173 



24 



Per cent of cures on admissions 

Per cent of cures on number treated . . 

Per cent of deaths on admissions 

Per cent of deaths on number treated. 



38 

9 

36 

8 



Proportion of insane (in asylums) to population, one in eleven hun- 
dred and thirty, or ratio per one thousand 



.88 



Number of Lunatic Asylums 12 

Cost of Maintenance. 

At Reinier Yan Arkel: 

First class, seven hundred florins, and twenty -five florins as entrance 
fee. 

Second class, four hundred florins, and twelve florins as entrance fee. 

Third class, two hundred and twenty-five florins, and are clothed by 
the Institute. 

At Meerenberg: 

First class, one thousand florins. 

Second class, seven hundred and fifty florins. 

Third class, five hundred florins. 

Fourth class, three hundred florins. 

Fifth class, two hundred and seventy florins. 

At Rotterdam (for indigents) : 

Two hundred and forty florins. Twelve other patients pay one florin 
per day extra for better accommodations. 

Average weekly cost for indigents, one dollar and eighty-eight cents. 

The principal assigned causes of insanity (mentioned in reports) are: 
hereditary, intemperance. 

The principal causes of death are: marasmus, consumption, apoplexy, 
general paralysis. 



In three asylums visited in 1870, the number of patients resident 

was 

Admitted 

Treated 

Cured '. 

Pied 



1,245 
321 

1,566 
123 
145 



Per cent of recoveries on admissions 

Per cent of recoveries on number treated. 

Per cent of deaths on admissions.... 

Per cent of deaths on number treated 



38 
7 

45 
9 



25 



INSANITY IN DENMARK. 



Population, 1860 

Total number of insane. 



2,605,024 
5,135 



Proportion to population, one in five hundred and seven, or ratio 
per one thousand 



1.97 



Proportion of insane (under treatment) in public institutions to pop- 
ulation, one in sixteen hundred and thirteen.* 



INSANITY IN SWEDEN. 



Population, 1860 

Total number of insane. 



3,859,728 
7,512 



Proportion of insane to population, one in five hundred and thir- 
teen, or ratio per one thousand . 



1.94 



Patients in Asylums. 



Private. 



Pauper. 



Totals. 



1861 f. 

1864 j. 
186711. 



469 
553 
630 



530 
598 
641 



1,026 
1,151 
1,271 



Calculated population, 1864 4,091,594 



Proportion of insane under treatment, 1867, to population, one 
in three thousand two hundred and nineteen, or ratio per one 
thousand 



.31 



* See Knorlein's Report of Asylum, at Linz, published in 1866, p. 78. 
fHelso och Sjukvarden, 1861, pp. 30, 31. 
JHelso och Sjukvarden, 1864, pp. 26, 27. 
Q Helso och Sjukvarden, 1867, pp. 14, 15. 



26 



Number of insane in asylums and Houses for the Insane, January 

1st, 1864 

Admitted during the year 

Cured and improved 

Died 



Number treated 

Number January 1st, 1865. 



1,095 

332 

163 

91 

1,427 

1,151 



Per cent of cured and improved on admissions 

Per cent of cured and improved on number treated. 

Per cent of deaths on admissions 

Per cent of deaths on number treated 



49 
11 

27 
6 



Proportion of insane (under treatment) to population, one in three 
thousand five hundred and fifty-four, or ratio per one thousand. 



.28 



Annual cost per head, three hundred and twenty-eight rix dollars and 
seventy-nine ore (three hundred and forty-seven dollars and sixty-eight 
cents, nearly), averaging six dollars and sixty-eight cents per week. 



According to the census of 1855 the population was 

Number of in sane 

Proportion to population, one in nine hundred and thirty-five, 
or ratio per one thousand 



3,641,011 
3,893 

1.06 



INSANITY IN NORWAY. 



Population, 1864 


1,6 


68,254 






Number of patients in asylums January 1st, 1864 


557 


A dmit t e d 


394 


Cured 


124 


Died 


35 


Number treated in 1864 


951 


Number in asylums January 1st, 1865 


583 









Per cent of recoveries on admissions 

Per cent of recoveries on number treated. 

Per cent of deaths on admissions 

Per cent of deaths on number treated 



31 

13 

8 

3 



27 



Proportion of insane (in asylums) to population, one in two thou- 
sand eight hundred and sixty-one, or ratio per one thousand.... 



.34 



Number of asylums 8 



According to census of 1855 the population was ! 1,490,047 

Total number of insane , I 1,329 

Proportion to population, one in eleven hundred and twenty- 
one, or ratio per one thousand 



.89 



Doctor Bucknill, in eighteen hundred and fifty-seven, reckons the pro- 
portion of insane to the population as one in five hundred and fifty-one. 

Number of asylums in 1867 9 



Number of patients in asylums January 1st, 1867. 

Admitted 

Cured 

Died 



Number treated 

Number in asylums January 1st, 1868. 



667 

423 

140 

41 

1,090 

727 



Per cent of recoveries on admissions 

Per cent of recoveries on number treated. 

Per cent of deaths on admissions 

Per cent of deaths on number treated 



33 

12 

9 

3 



INSANITY IN NEW SOUTH WALES. 



Population, 1867 447,620 



Number of insane, including idiots 

Proportion of insane to population, one in three hundred and 
eighty-seven, or ratio per one thousand 



1,156 



2.58 



The number of lunatics under treatment, exclusive of invalids, in 
eighteen hundred and sixty-eight, was: 



28 





Pauper. 


Private. 


Totals. 


At Tarban 


397 
347 

744 


223 

189 

412 


620 


At Parramatta 


536 






Totals 


1,156 







In eighteen hundred and fifty-five the number of lunatics in the Gov- 
ernment Asylums was: 



At Tarban 

At Parramatta. 

Total 



197 
279 

476 



In eighteen hundred and sixty-eight the number was eleven hundred 
and fifty-six, an increase of six hundred and eighty in thirteen years, or 
an annual increase of fifty-two and four one hundredths. 

The cost of maintenance is: at Tarban, seven shillings and eight pence; 
at Parramatta, eight shillings and five pence. 



INSANITY IN THE UNITED STATES. 



Population, 1870 38,555,983 

Number of Insane. 



White 


35,560 


Black 


1,605 


Mulatto 


169 


Chinese 


35 


Indian , 


13 








Total 


37,382 








Number of Idiots. 




White 


21,324 


Black 


2,743 


Mulatto 


445 


Chinese 


5 




10 








Total 


24,527 







Number of insane and idiots 61,909 



29 



Proportion of insane to population, one in ten hundred and thirty- 
one, or ratio per one thousand 

Proportion of idiots to population, one in fifteen hundred and sev- 
enty-two, or ratio per one thousand 

Proportion of insane and idiots to population, one in six hundred 
and twenty -three, or ratio per one thousand 



.97 

.63 

1.06 



Number of insane under treatment.* 

Proportion of insane under treatment to population, one in two 
thousand one hundred and seventy-three, or ratio per one 
thousand 



17,735 



.46 



Number of patients in asylums, 1870 f j 15,792 

Admitted during the year f ! 10,229 

Cured f ! 3,357 

Diedf ! 1,851 

Number treated f ! 26,021 



Per cent of cures on admissions 

Per cent of cures on number treated.. 

Per cent of deaths on admissions 

Per cent of deaths on number treated. 



33 
13 
18 

7 



Number of Asylums. 



Public Asylums. 
Private Asylums 

Total 



50 
16 

6Q 



The principal assigned causes of insanity: ill health, spermatorrhoea, 
intemperance, domestic trouble, physical disease, religious excitement, 
epilepsy. 

Principal causes of death : exhaustion (from various causes), epilepsy, 
general paralysis, and consumption. 



* As nearly as can be ascertained from returns. 

t Keport for forty -nine asylums. Keturns could not be obtained from the others. 



30 



In thirty -nine asylums visited in 1870, the number resident was. 

Admitted 

Cured 



Died 

Number treated. 



12,907 
8,639 
3,240 
1,519 

21,504 



Per cent of cures on admissions 

Per cent of cures on number treated.. 

Per cent of deaths on admissions 

Per cent of deaths on number treated. 



37 
15 
17 

7 



Years. 


Population. 


Insane. 


Idiots. 


Total. 


ffio 
o • 

co 

Uh 

£3 

• p 

CD 


co HH 

►d p 

►-•CO 


Per ct. sup'd 
with hospital 
accommod's. 


1850 
1860 , , 

1870 , 


23,191,876 
31,443,322 

38,555,983 


15,610 
23,999 

37,382 


15,787 
18,865 
24,527 


31,397 
42,864 
61,909 


28 
46 
66 


4,730 
*8,500 
17,735 


30.30 
35.42 
47.44 



INSANITY IN CALIFORNIA. 



Population, 1870 560,247 



Native population .. 
Foreign population. 



Total. 



350,416 
209,831 

560,247 



Number of Insane. 





Males. 


Fem'les 


Totals. 


White 


789 
15 


304 

2 


1,093 


Black 


17 


Mulatto 






29 

2 

835 


4 
1 

311 


33 




3 






Totals 


1,146 







* See Journal of Insanity, Vol. XVIII, p. 2. 



31 



Number of Idiots. 



Males. 


Fem'les 


48 


29 


2 
1 




1 


4 


1 


1 







56 


31 



Totals. 



White 

Black 

Mulatto.... 
Chinese.... 
Indian 

Totals 



77 
2 
2 
5 
1 

87 



Insane and Idiots classified as Native and Foreign. 





Insane. 


Idiots. 


Totals. 




408 

738 


70 
17 

87 


478 


Foreign 


755 






Totals 


1,146 


1,233 







Proportion of insane to population, one in four hundred and eighty- 
nine, or ratio per one thousand 

Proportion of idiots to population, one in six thousand four hun- 
dred and thirty-nine, or ratio per one thousand 

Proportion of insane and idiots to population, one in four hundred 
and fifty-four, or ratio per one thousand 



2.04 

.15 

2.20 



Number of insane under treatment 

Proportion under treatment to population, one in five hundred 
and thirty-five, or ratio per one thousand 



1,047 



1.86 



Proportion of native to total insane... 
Proportion of foreign to total insane.. 

Total 



35.60 
64.40 

100.00 



32 



Number of patients in Asylum January 1st, 1870, 

Admitted during the year 

Cured 

Died 

Number treated 



920 
562 
221 
156 
1,483 



Of the whole number of insane, ninety-one and three tenths per cent 
are under treatment. 



CHAPTEK IV. 



CAUSES OF INSANITY, AND SOME OP THE INFLUENCES OPEKATING 

IN ITS DEVELOPMENT. 

General Observations — Assigned Causes— Physical Causes — Moral Causes — Observations 
upon Assigned Causes — Principal Assigned Causes — Insanity Found in all Countries — 
Enumeration of the Insane — Tables Relating to Enumeration — Enumerations Imper- 
fect — Difficulties in the way of a Perfect Enumeration — Influence of Age — Influence of 
Age in the Different Races — Influence of Sex — Influence of Marriage. 

GENERAL OBSERVATIONS. 

From the formidable array made by such an army of insane men and 
women, as it is seen with its banners flying in every civilized country, it 
behooves us to pause and give it thought; to ascertain as nearly as may 
be what causes are most prolific in its production; what conditions of 
society most readily lead to its development, and how best to meet its 
attacks and arrest its onward march, " more terrible than an army of 
banners." Let us first inquire into the causes producing this malady. 
In ancient times insanity was attributed to supernatural causes, but as 
science advanced and shed its light upon the human race this supersti- 
tion passed away, until at the present time the causes which lead to it 
are known to be as varied as those which affect the physical system, as 
will be seen from the following table, taken from a paper on the supposed 
increase of insanity, read before the Association of Medical Superinten- 
dents of American Institutions for the Insane, by Dr. Jarvis, of Massa- 
chusetts, at their annual meeting at Philadelphia, May, eighteen hundred 
and fifty-one: 

ASSIGNED CAUSES OF INSANITY. 



Physical Causes. 

Congestion of the brain. 

Disease of the brain. 

Phrcenitis. 

Epilepsy. 

Arachnoiditis. 

Apoplexy. 

Convulsions. 

Hydrocephalus. 

Nervous irritation. 



Moral Causes. 

Mental labor and excitement. 
Mental fatigue. 
Mental shock. 
Mental perplexity. 
Excessive study. 
Study of metaphysics. 
Study of phrenology. 
Excitement of lawsuit. 
Politics. 



33 



Physical Causes. 

Excessive pain. 

Neuralgia. 

Typhus fever. 

Nervous fever. 

Bilious fever. 

Scarlet fever. 

Intermittent fever. 

Yellow fever. 

Gastritis. 

Measles. 

Gout. 

Dyspepsia. 

Dysentery. 

Erysipelas. 

Phthisis. 

Rheumatism. 

Bilious rheumatism. 

Suppression of hemorrhoids. 

Suppression of perspiration. 

Suppression of secretions. 

Suj)pression of eruption. 

Suppression of tumor. 

Suppression of fistula. 

Smallpox. 

Varioloid. 

Irritation of the spine. ■ 

Disease of the spine. 

Ill health. 

Ill health and solitude. 

Ill health and perplexity in busi- 
ness. 

Ill health and family trouble. 

Ill health and pecuniary difficulties. 

Ill health and lawsuit. 

Old age. 

Irregular decay of powers in old 
age. 

Congenital. 

Hereditary. 

Injuries. 

Concussion of brain. 

Lesion of brain. 

Blow on the head. 

Fracture of the head. 

Burn on the head. 

Malformed head. 

Fall. 

Kick on the stomach. 

Surgical operation. 

Mesmerism. 

Insolation. 

"Want of exercise. 



Moral Causes. 

Political commotions. 

Excitement of Mexican war. 

Excitement of visiting. 

Sea voyage. 

License question. 

Anti-rent. 

Fourierism. 

Preaching sixteen days and nights. 

Blowing fife all night. 

Application to business. 

Reading vile books. 

Seclusion. 

Sudden joy. 

Hope. 

Faulty education. 

Day dreaming. 

Extatic admiration of works of art. 

Seduction. 

Domestic affliction. 

Domestic trouble. 

Family affairs. 

Bad conduct of children. 

Ill treatment. 

Ill treatment from husband. 

Ill treatment from parents. 

Abuse from husband. 

Infidelity of husband. 

Infidelity of wife. 

False accusation. 

Imprisonment for crime. 

Difficulty in neighborhood. 

Avarice. 

Anticipation of wealth. 

Speculation in stocks. 

Speculation in morus multicaulis. 

Speculation in lottery tickets. 

Perplexity in business. 

Pecuniary difficulties. 

Disappointment in business. 

Loss of money. 

Loss of property. 

Reverse of fortune. 

Fear of poverty. 

Death of relations. 

Death of husband. 

Death of father. 

Death of son. 

Sickness and death of a friend. 

Sickness and death of friends. 

Sickness and death of kindred. 

Murder of a son. 

Anxiety. 



34 



Physical Causes. 

Sedentary habits. 

Idleness. 

Insolation and drinking cold water. 

Exposure to excessive heat. 

Exposure to cold. 

Bathing in cold water. 

Sleeping in a barn filled with new 

hay. 
Tight lacing. 
Excess of quinine. 
Metallic vapor. 
Prussic acid vapor. 
Charcoal vapor. 
Pregnancy. 
Parturition. 
Abortion. 
Puerperal. 
Cold in childbed. 
Lactation. 

Sexual derangement. 
Disease of uterus. 
Irregular menstruation. 
Profuse menstruation. 
Suspended menstruation at change 

of life. 
Suppressed menstruation. 
Hysteria. 
Carbonic acid gas. 
Working in white lead. 
Acetate of lead. 
Excessive labor. 
Bodily exertion. 
Loss of sleep. 
Intemperate use of snuff. 
Intemperate smoking. 
Intemperate opium eating. 
Syphilis. 
Yice. 
Immorality. 



And winds up by saying: "These are not all the diseases, accidents, 
events, etc., that can disturb the regular action of the brain." 



Moral Causes. 

Anxiety and loss of sleep. 
Anxiety for absent friends. 
Home sickness. 
Fright. 

Disappointment. 
Disappointment in love. 
Disappointment in ambition. 
Unrequited love. 
Want of employment. 
Want of occupation. 
Destitution. 
Mortified pride. 
Ungoverned passion. 
Virulent temper. 
Misanthropy. 
Jealousy. 
Envy. 
Duel. 

Eeligious anxiety. 
Eeligious excitement. 
Remorse. 
Millerism. 
Mormonism. 

Struggle between the religious prin- 
ciple and power of passion. 
Epidemic influences. 



OBSERVATIONS UPON ASSIGNED CAUSES. 

From this formidable list of assigned causes of mental disturbance we 
see there is scarcely a disease of the body, an emotion of the mind, or a 
feeling of the heart that may not act as an exciting, if not an actual 
cause in the dethronement of man's reason. " Dr. Ludwig, of the Hep- 
penheim Asylum, expressed the opinion that the cause of insanity is 
extremely obscure and not easily defined, and thinks that most of the 
assigned causes are made at the writing desk of the Committing Boards; 



35 

that predisposition must exist, and that the form is only the effect, not 
the cause." We very well know that mistakes are often made by Com- 
mitting Boards, even when composed of physicians, and that symptoms 
are too often mistaken for disease; nevertheless we cannot agree with 
Dr. Ludwig and other German Superintendents who assign nearly all 
cases of lunacy to hereditary taint. Intemperance was admitted by a- few 
of those with whom we conversed to be a cause of mental disturbance, 
but all others were set aside as unworthy of being assigned a place. 
Dr. Koeppe, the intelligent Director and Physician in Chief of the cele- 
brated Asylum at Halle, in Prussian Saxony, informed us that eighty 
per cent of those committed to his Asylum were from hereditary causes, 
and that this was in accord with the experience of the Superintendents 
of other institutions in Germany. To say the least, this does not agree 
with the opinions of the learned and practical men who have charge of 
Asylums in most other countries, and especially in Great Britain and the 
United States. 

The preceding hst was inserted as a matter of general interest. The 
following table comprises the principal assigned causes of insanity: 



36 



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37 

INSANITY FOUND IN ALL COUNTRIES. 

As the causes enumerated in this Chapter operate with more or less 
power and energy in producing insanity, we learn that it is found in all 
countries and among all nations, but is more prevalent among civilized 
than among savage people. It is true that we have no statistical data 
upon which to predicate this assertion, as no census of the insane has 
ever been taken in savage or semi-barbarous nations. From those who 
have resided in these countries, and from travellers who have gone 
among them, we learn that but little insanity is known among them. 
Caleb Cushing, former United States Minister, states that after a some- 
what protracted residence in China he had concluded there were but few 
lunatics to be seen or heard of. Mr. Williams, an American missionary, 
after a residence of twelve years, says that he only saw two who were 
"upside down," as the Chinese call it, during the whole time. 

All travellers agree that it scarcely exists in Nubia, and that it is 
extremely rare in Egypt. In eighteen hundred and forty-four, according 
to a statement in the London Medical Gazette, there were only fourteen 
in Cairo, being one to twenty-three thousand five hundred and seventy- 
two of the population. A few isolated cases have been reported by 
Doctors Moreau and Furnari, among the tribes bordering on the African 
shores of the Mediterranean, but agree in the general conclusion as to its 
scarcity. Doctor Furnari thinks it is in consequence of their "total 
abstinence." 

Doctor De Forest, of the Syrian Mission, in a letter to Doctor Butler, 
of America, says: "It is impossible to obtain accurate statistics of the 
insane here, but I think the disease far less frequent than in our own 
land." He gives a fearful picture of the treatment of those who are 
unfortunate enough to be insane. Doctor Paulding, in the Boston Medi- 
cal and Surgical Journal (1852), bears testimony to the same facts. 

Doctor Wise, Superintendent of an asylum in Bengal, states as the 
result of his experience, "that insanity is less frequent and assumes a 
less acute form among the East Indians than among the civilized nations 
of Europe." Captain Wilkes, of the United States Exploring Expedi- 
tion, in a letter to Doctor Brigham, says: "During the whole of my 
intercourse with the natives of the South Sea I met no deranged person. 
I am confident that had any instance of mental derangement among the 
natives occurred, it would have been observed by us." 

We all know in this country that for a long time it was supposed that 
no Indian had been known to become insane; and so we might show of 
all other countries where savages are found in similar conditions, if 
deemed important. That it exists in much larger proportions in Europe 
and America scarce needs be stated, as it is a fact well known to all who 
have paid the least attention to the subject, and will be abundantly 
proved in this report. That it is not due to any peculiarity of race will 
also be shown, at least with regard to some of these peoples, when 
brought in contact with more civilized nations and subjected to the 
influences by which it is developed. 

It is believed to be due to causes inherent in man, or connected with 
his condition, habits, and exposures. 

Some of these causes belong to the body, as physical diseases — 
apoplexy, epilepsy, palsy, scrofula, injuries to the head, general ill health, 
consumption — and some are called moral causes, such as anxiety, exces- 
sive study, grief, remorse, distress, struggles for gain, ambition. Some 
of these causes apply to the savage as well as civilized nations, while 



% 38 

Others are applicable exclusively, or nearly so, to a condition of civili- 
zation. They vary in their frequency, intensity, and power, and conse- 
quently the mental diseases also differ in frequency and durability; to 
what extent we will endeavor to show, in a measure at least, hereafter. 
For the present we desire to exhibit their combined effect upon those 
subjected to their influence. 

ENUMERATION OF THE INSANE. 

Most nations in their enumerations take account of the insane; thus 
we find their numbers as seen in the following tables: 



39 
Table 







Population. 


Numbers of Insane 
and Idiots. 


Proportion of— 


COUNTRY. 


Insane 


Idiots. 


Total. 


Insane to 
Popula- 
tion. 


Idiots to 
Popula- 
tion. 


Total to 
Popula- 
tion. 


United States 
Scotland 


1870 
1870 
1870 
1870 
1866 
1867 
1865 


38,555,983 
22,090,163 

3,222,837 

* 5,195,236 

37,988,905 

23,971,337 

4,984,451 


37,382 


24,527 


61,909 
54,713 

9,571 
17,194 
90,679 
37,960 

7,431 


1 in 1,031 


1 in 1,572 


1 in 623 
1 in 403 
1 in 336 
1 in 302 











Ireland 


11,122 
50,726 
16,929 


6,072 
39,953 
21,031 


1 in 467 
1 in 747 
1 in 1,416 


1 in 855 


France 


1 in 950 i 1 in 418 


Prussia 


1 in 1,139 1 in * 31 






1 in 6vl 


| 






Total 




136,008,912 






279,457 


1 in 486 



















Table. f 



Countries. 



Census ta- 
ken once 
in : 



o 
3 



O 



Populat'n. 



Number of Insane. 



Males. 



Feml's 



Proport'n 
to 
Totals. 1 Populat'n 



Ireland 

England and Wales.. 

Newfoundland 

Nova Scotia 

Prince Edward's Island- 
United States 

Prance 

Savoy 

Belgium 



Holland , 

Hanover 

Prussia , 

Saxony 

Bavaria 

"Wurtemburg 

Hesse Darmstadt 

Oldenburg 

Denmark 

Sweden 

Norway , 

Piedmont ....« 



10 years 

10 years 

10 years 

10 years 

7 years 

10 years 

5 years 

■ 4 years 

10 years 

10 years 

3 years 

3 years 

3 years 

3 years 

3 years 

3 years 



5 years 

5 years 

10 years 

10 years 



* Calculated population. 

t From Vital Statistics of Ireland. 



1861 
1861 
1857 
1861 
1861 
1860 
1856 
1861 
1856 
1859 
1861 
1858 
1861 
1861 
1861 
1861 
1855 
1860 
1855 
1855 
1858 



5,798,967 

20,066,224 

122,638 

330,857 

80,857 

31,445,080 

36,012,669 

542,535 

4,529,560 

3,308,969 

1,888,048 

17,739,913 

2,225,240 

4,689,837 

1,720,708 

856,907 

287,163 

2,605,024 

3,641,011 

1,490,047 

5,041,853 



3,500 

11,249 

50 

166 



143 
2,019 
1,038 
1,591 



2,576 
690 



446 
2,543 
1,898 

619 



3,565 

13,096 

38 

174 



167 
1,998 
1,101 
1,493 



7,065 

24,345 

88 

340 

148 

23,999 

35,031 

310 

4,017 

2,139 

3,084 



2,323 
648 



1,559 
4,899 
1,338 



508 
2,592 
1,995 

710 



954 
5,135 
3,893 
1,329 
1,750 



m 821 

in 824 

in 1,394 

in 973 

in 546 

in 1,310 

in 1,028 

1 in 1,750 

1 in 1,128 

1 in 1,547 

1 in 612 



1 in 1,427 
1 in 957 
1 in 1,286 



lin 301 
1 in 507 
1 in 935 
1 in 1,121 
1 in 2,881 



40 
Table 





• 1844.* 


1850.f 


1857.J 


1860.§ 


1867.1! 


Countries. 


Population 


Insane. 


Eatio. 


Eatio. 


Eatio. 


Eatio. 


Eatio. 


Srtain 


4,058,000 

16,789,000 

3,816,000 

2,302,000 

32,000,000 

17,069,453 

120,000 

1,283,142 

13,089,358 

7,784,536 

2,365,807 

1,051,300 

262,948 

1,400,000 
890,000 
377,000 
370,000 
330,000 
204,000 
154,000 
151,000 
114,000 
80,000 
70,000 
'37,583 


569 

3,441 

3,763 

2,300 

32,000 

17,457 

130 

1,535 

16,222 

10,059 

3,652 

1,909 

488 

7,000 

4,000 

120 

479 

14 

60 

320 

618 

331 

236 

150 

104 


1 in 7,180 
1 in 4,876 
1 in 1,014 
1 in 1,001 
1 in 1,000 
1 in 977 
1 in 932 
1 in 846 
1 in 807 
1 in 774 
1 in 648 
1 in 551 
1 in 539 

1 in 200 
1 in 222 
1 in 3,142 
1 in 772 
1 : 23,572 
1 in 3,400 
1 in 480 
lin 244 
1 in 341 
1 in 339 
1 in 446 
lin S6VA 


1 in 7,181 
1 in 3,785 




1 in 1,667 
1 in 3,690 
1 in 816 
1 in 1,223 
1 in 1,773 




ifaly 
















France 


1 in 1,000 


1 in 795 


lin 444 


United States. 




Malta & Gozzo 






"Westphalia... 




1 in 577 


1 in 700 
1 in 2,125 
1 in 513 
1 in 550 




1 in 666 


1 in 432 
1 in 325 


Scotland 


1 in 400 
1 in 531 




lin 368 


Brunswick 


1 in 551 






Cities. 




















Petersburg ... 
Naples 












































Milan 
















Florence 














Brunswick 



















ENUMERATIONS IMPERFECT. 



These statements of the insane are doubtless imperfect in all countries, 
and certainly very imperfect in some of them. It is impossible to obtain 
full accounts of the insane through public offices as at present organ- 
ized, and any other and more perfect system would probably be deemed 
too expensive by most Governments. We have reason to believe that 
many are concealed from public view, and that families refuse to report 
them to ordinary officers. 

DIFFICULTIES IN THE WAY OF PERFECT ENUMERATION. 

Massachusetts seems to have understood and appreciated these diffi- 
culties at an early date, and in eighteen hundred and fifty-four 
appointed a Commission, consisting of Levi Lincoln, Doctor Edward 
Jarvis, and Increase Sumner, to ascertain the number and condition of 



* See London Medical Gazette, April, 1844. 

t American Journal of Insanity, Vol. VII, p. 286. 

J Bucknill & Tuke on Insanity, p. 47. 

\ Journal of Insanity, Vol. XVII, p. 348. 

j| Manning's Eeports, p. 109. 



41 

the insane in the State; distinguishing as accurately as may be between 
the insane, properly so considered, and the idiotic or non compos; between 
the furious and harmless; curable and incurable; and between the 
natives and foreigners, and the number of each who are State paupers. 
(See Insane and Idiots, Mass. 1854). 

This Commission addressed circulars to every physician in the State, 
setting forth the facts that they desired to obtain, and asking their 
assistance and cooperation. There were at that time fifteen hundred 
and fifty-six physicians in the State, of whom all but four responded, 
giving every case within their knowledge. 

Besides these, many of the clergy, Overseers of the Poor, and other 
persons known or supposed to be interested in or informed upon the 
subject were consulted and their assistance asked. 

After twelve months of constant, persistent, and untiring labor the 
most complete, able, and satisfactory report ever made of the insane and 
idiots in any State or country was the result. It was not only impor- 
tant to Massachusetts, but to all other States and countries. The subject 
of inquiry was of a general character, and the facts found and infer- 
ences deduced as applicable to all the world as to Massachusetts. 

Without going into the details of the modus operandi by which the 
information was obtained, it is sufficient to state the result in a few par- 
ticulars. Of the lunatics found, fifteen hundred and twenty-two were 
paupers, and eleven hundred and ten were supported by their own prop- 
erty or by their friends, making a total of two thousand six hundred 
and thirty -two, or one to every four hundred and twenty-seven of the 
population; whereas an enumeration made by another Commission, in a 
different way, a few years previously (eighteen hundred and forty-eight), 
showed only one to five hundred and ninety -two of the population. The 
United States census of eighteen hundred and sixty showed one to five 
hundred and eighty-five, and in eighteen hundred and seventy, one to 
five hundred and forty-seven. These figures demonstrate the imperfec- 
tions of general enumerations, and the difference exhibited by a census 
perfectly taken. This difference, we think, may safely be added to the 
enumerations made in other countries. 

INFLUENCE OF AGE. 

Among the causes of insanity, age is supposed to have its influence; 
at all events, it is a fact established by the observations of most men 
who have written upon the subject that a larger proportion become 
insane between the ages of thirty and forty than at any other period of 
life. The general enumerations of the insane do not show their ages, 
but this is stated in all those who are, committed to hospitals, and thus 
the deficiency is in a measure supplied, and we are thereby enabled to 
arrive at approximate conclusions. 

There are, however, some notable exceptions to this general rule. 
The experience of Esquirol at Charenton showed the largest number of 
admissions between twenty and thirty. The experience of Doctor Erie 
at Bloomingdale, and that of Doctor Hood during ten years at Bethlem, 
is in accord with that of Esquirol at Charenton, though the whole expe- 
rience of Esquirol was in accordance with the general rule, while that 
of Doctor Tuke was in favor of the earlier period, between twenty and 
thirty. It will be seen by the following table that in France, Italy, and 



42 

Holland the greatest number become insane between the ages of thirty 
and forty, while in Ireland and at the York Eetreat the greater number 
was between twenty and thirty. The table also shows that the numbers 
decrease as we ascend or descend the scale. This result may be attrib- 
uted to the fact that at that period of life both males and females are 
more exposed to the various exciting causes than at any other. It is 
contended by some authors, however, that the age between thirty-five 
and forty exercises a special influence over the production of insanity; 
but of this we have no other evidence than that already cited. The fol- 
lowing table will show the influence of age, illustrated by statistics of 
different countries: 

Table. 

Influence of Age, illustrated by Statistics of Different Countries. 





France. 
1853. 


Ireland. 

District Asy- 
lums, 1870. 


Italy. 

Florence 

Asylum, 

1868. 


Holland. 
1844 to 1864. 


Total. 




3 


hj 


tszj 


hj 


2| 


hj 


3 


Hd 


^ 


^ 


AGE. 


B 


o o 


B 




1 


P 2 

°8« 




B 3 




p*s 




a 4 

CD 


P o 

J? J. 


CD 

4 


EL,o 


D 

-i 


a o 

O rt; 


cT 


15 o 

3 2". 


CD 

4 








4 


P o 






B o 




<r+- O 






rt-O 






B 
O P 








O 3 

^ p 






O P 
3 P 




p 


















a rt- 






a e+ 




r?s 






— 'p 






3 ^ 








£ § 






P P 






■ cl- 












P s» 








09 a 






cr<3 a 






eTi 












P o 








o fr 1 






cd p- 1 






: p 






P 






oq P* 














: «+■ 






. o 






O 






CD ^ 






: o 




• c 




: pr 




tsr 1 




S° O 


Under 10 years \ 
10 to 20 years... J 


1,809 


5.90 


{ 2 

1 187 


.08 
8.14 


3 

18 


.96 

5.73 


66 

653 


.56 

5.57 


" J 2,738 


6.08 


20 to 30 years 


5,912 


19.27 


713 


31.05 


68 


21.66 


2,681 2 


2.87 


9,374 


20.83 




8,470 


27.61 


593 


25.83 


77 


24.52 


3,045 2 


5.98 


12,185 


27.08 




7,011 


22.86 


374 


16.29 


66 


21.02 


2,370 2 


0.22 


9,821 


21.82 




4,610 


15.03 


229 


10.00 


41 


13.06 


1,672 ] 


4.27 


6,552 


14.56 




2,022 


6.59 


145 


6.31 


24 


7.64 


867 


7.40 


3,058 


6.79 




839 


2.74 


53 


2.30 


17 


5.41 


367 


3.13 


1,276 


2.84 


Unknown 


2,203 




37 












2,240 




















Totals 


32,876 




2,333 




314 




11.721 .. 




47-244 

































Doctor Tuke says: "During the forty four years between seventeen 
hundred and ninety-six and eighteen hundred and forty, of those 
admitted at the Retreat the greater number (one third of the whole) 
were attacked between twenty and thirty years of age. Each subsequent 
decennial period is marked by a gradually decreasing proportion. Thus, 
of every hundred cases at the origin of the disorder there were, at suc- 
cessive periods of life, as follows: 



0-10 


10-20 


20-30 


30-40 


40-50 50-60 


60-70 


70-80 


80-90 


.96 


12.77 


32.53 


20.00 


15.9 


10.6 


6.3 


.97 


.24 



43 

" Now it is obvious that to render these statistics of any value they 
must be compared with the numbers living in the same community at 
the same periods of life. This means of comparison we afford in the 
following table. 

" Of every hundred individuals there were living, at successive decen- 
nial periods of life, as follows: 



0-10 


10-20 


20-30 


30-40 


40-50 


50-60 


60-70 


70-80 


80-90 


16.7 


18.9 


15.4 


12.4 


11.9 


10.8 


7.8 


4.9 


1.2 



" From which it is evident that the large proportion of persons who 
become insane, of those admitted at the Retreat, between twenty and 
thirty years of age, cannot be explained by the greater proportion of 
the number living at that period. On the contrary, there were more 
living under ten years of age and between ten and twenty. These facts, 
therefore, exhibit an increased liability to insanity connected with the 
age between twenty and thirty; or man during that period is brought 
into contact with an increased number of the causes of insanity. It is 
probable that it is the combination of these two circumstances which 
induces this result."* 

In eighteen hundred and fifty the greatest number of inhabitants of a 
given age in the United States was under ten, the next greatest between 
ten and twenty, and so on, gradually decreasing to the end. We pre- 
sume that these proportions have been maintained to the present time; 
and as we have not by us any census of a later date setting forth this 
particular fact, we have made use of it in preparing the following table, 
taking, however, the number of insane for eighteen hundred and seventy 
instead of eighteen hundred and fifty, and leaving idiots out of the com- 
putation. From this it will be seen that though there are many more 
persons living under ten, between ten and twenty, and between twenty 
and thirty, than between thirty and forty, still the number of insane of 
the latter age are greatly in excess of those of any other age. 



* See Bucknill & Tuke on -Insanity, p. 245. 



44 
Table. 

Influence of Age illustrated by Statistics of the United States. 



AGE. 






o 



00 

o 



Proportion at each 
age to total of 
known ages. 



Popula'n 



ISTo.Ins'e 



Under ten years 

From ten to twenty years 

From twenty to thirty years 

From thirty to forty years 

From forty to fifty years 

From fifty to sixty years 

Prom sixty to seventy years , 

From seventy to eighty years , 

From eighty to ninety years , 

From ninety to one hundred years 
One hundred years and upwards. 
Unknown , 

Totals 



6,739,041 
5,420,421 

4,277,318 

2,825,819 

1,846,660 

1,109,540 

609,926 

257,234 

77,382 

11,695 

2,555 

14,285 



23,191,876 



324 
1,992 
7,096 
9,109 
7,976 
5,264 
3,307 
1,569 

455 
62 
15 

213 



37,382 



29.08 

23.38 

18.46 

12.19 

7.97 

4.79 

2.63 

1.11 

.33 

.05 

.01 



100.00 



.87 

5.36 

19.09 

24.51 

21.46 

14.16 

8.90 

4.22 

1.22 

.17 

.04 



100.00 



INFLUENCE OF AGE IN THE DIFFERENT RACES. 

The following table has been made for the purpose of showing the 
susceptibility to insanity of the different races inhabiting our continent, 
and the ages at which they are most liable to the seizure of this terrible 
malady. 



45 



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46 

The preceding table shows a most interesting fact, that may or may 
not be overthrown by further investigation and longer experience. It 
will be observed that while the general rule under discussion holds good 
with the Chinaman and the Indian, that both the black and mulatto are 
most liable to become insane between twenty and thirty, and that this is 
true with regard to both males and females. This may be the result of 
accident; but from our knowledge of the race, derived from a long resi- 
dence among them in the Southern States, we are of the opinion it is the 
result of a natural law. Their development, both intellectual and physi- 
cal, is of much earlier growth and maturity than that of the Caucasian, 
and as insanity seems to attack the human race most frequently at that 
age when all the faculties are in fullest maturity, and most powerful, 
energetic action, there would seem to be no reason why the negro should 
be an exception to the general law. These reflections, however, are 
made more to direct the attention of future investigation to the subject 
than with a view to the promulgation of a new theory or the enuncia- 
tion of a new idea. 

INFLUENCE OP SEX. 

The susceptibility of the sexes to insanity has been a debateable ques- 
tion from the days of Cselius Aurelianus to the present time, most of 
those participating in the discussion seeming to be guided by their indi- 
vidual experience or their immediate surroundings. Aurelianus, Pinel, 
Haslam, and their followers taking sides with the women, while Esqui- 
rol, Copeland, Browne, and others took the other side of the question. 
In our country, Doctor Rush was of the opinion that more women were 
insane from the fact that they are exposed to several exciting causes 
from which men are exempt, apparently overlooking another fact, that 
men are liable to many causes from the influence of which females are 
partially or entirely removed. Doctor Jarvis, one of the closest observ- 
ers and most thorough investigators whose writings have come under 
our observation, came to the conclusion some twenty years ago, after 
exhausting all the information that existed on the subject at that time, 
that a few more men than women become insane. (Jarvis on the Com- 
parative Liability of Males and Females to Insanity; see American Jour- 
nal of Insanity, Vol. VII, p. 142.) And from the following table of first 
admissions into the Asylums of England, Ireland, France, Belgium, Hol- 
land, and Bavaria, during the period specified, it would seem that the 
conclusion at which he then arrived still holds good; though according 
to the United States census for eighteen hundred and seventy the reverse 
of this would seem to be true in our country, as the number of male? 
was eighteen thousand one hundred and seventy-four; the number t, 
females, nineteen thousand two hundred and eight, or an excess of one 
thousand and thirty-four females. 



47 
Table, 

Showing the Influence of Sex. 



COUNTRIES. 



Period. 



Number of First Admissions. 



Males, i Females. 



Veals. 



England 

Ireland 

Franc e 

Belgium 

Holland 

Bavaria (Asylum at Irsee).. 

Totals 



1870 

1870 

1853 

1865 

1844 to 1864 

1858 to 1868 



5,124 
1,141 

3,959 
865 

4,747 
388 



4,966 
971 

3,487 
690 

4,526 
324 



16,224 



14,964 



10,090 
2,112 

7,447 

1,555 

9,273 

712 

31,188 



The various arguments made and facts adduced to prove the one 
theory or the other, are conclusive evidence to our mind that there is 
but little difference in the gross number of the sexes. As classes they 
seem about equally subject to this malady, yet different causes operate 
in various proportions on the sexes. Men are more intemperate, which 
is well known to be one of the most prolific causes of insanity, its vic- 
tims being in proportion of about four men to one woman. More men 
are engaged in hazardous enterprises and doubtful business speculations, 
in gambling and other dissipation, more subject to disappointment and 
failure in business operations, more use their brains excessively in study, 
in scientific investigations and ambitious projects, and more are liable to 
ordinary accidents and the casualties and exposures of war. 

On the contrary, domestic trials, ill health, loss of relatives, and disap- 
pointments in love act more powerfully on women, w T hile a few other 
causes belonging to peculiarities of organism affect them only. We must 
conclude, therefore, that the liability of the excess to insanity is very 
nearly equal, and that any difference in numbers in different countries 
and localities depends more on the exposure to the various causes that 
produce it than to difference of liability in the sexes; and these must 
vary with different nations, different periods of the world, and different 
habits of the people. The fact that the percentage of recoveries is 
slightly greatest among females, and a fortiori, the percentage of deaths 
among males, is too well established to require an argument. The reason 
of this is obvious; we have already seen that the causes operating on 
the sexes are different in some important particulars; general ill health 
and the puerperal condition adding largely to the list among females, 
give to insanity its most curable cases; while epilepsy, palsy, and mas- 
turbation are more frequent causes among men, and are among the most 
incurable cases. 

INFLUENCE OP MARRIAGE. 

The experience of all writers upon the subject, as far as our observa- 
tion has extended, shows conclusively that a greater number of single 
than married persons become insane, notwithstanding there are more of 
the latter class of the ages most subject to insanity. 



48 









« 








?». 




Sk 




1 




^ 




o 






3 


CO 

c_> 


•J 


si 


m 


CO 


<J 


^ 


en 


L? 

M 




co 




r< 




to 




*3> 




K 



SQ 



o 



w CO 
. O fl 

'St^ o 



.►S s.-s 



Ph 



ft-H 






PI 
oS 
t~ 

CO 

00 ^-v 

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O CO 

© 

o 
r— « 



© . 

©co 

S3 ID 
03 CO 
P r-t 

ft 



03 



^co 

^ CO 

© r-t 



Totals... 



Female. 



Male. 



Totals- 



Female. 



Male. 



Totals- 



Female. 



Male. 



Totals. 



Female. 



Male. 



Totals- 



Female. 



Male. 



H3 

So 

M 



f Totals. 



Female. 



Male. 



T ° 

O 



OOHX 
1- CO l- tO 

rH_^oq_Oi_ 

oTcO CO~CO 
CM r-( 



HHiOH 
CO -* tO OS 
rH_OS_l>^^ 

co"co"ofr-r 



OS OS CO l^ 

CO i— I tH CO 
OlOHTjt 



CO tO T* 
tO i— I CO 
lO to ^ 



■* CO i-l 
00 00 CO 

OHCO 



oq cm co 

Jh- CO CO 

-*COH 



lO O CO 
CO CO "<tf 

00 -^ iH 



!>-* OS 
tDNO 
COCS iH 



00 CO ^ 
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rj< r-l 



00 CO OS CO 

i^ os i^ cm 

CD.Tf^CO^CO^ 

co""ao"of co* 



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O -*00 CN 
00 r* 00 CO 



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r-ico tj< : 
co cn : 


CO 
-^ 
rH 

r-T 


1^00 CO CM 
tO -* (M CO 
CM^rjl CO 

to"r-T 


O 

CO 


i-l t^O CM 
lO ■* r-l CO 
CM^t- CO iH 

of 


o 
co" 


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qi- i-i i-i 

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o 

OS 

co" 






49 

From the foregoing table we find that out of every one t 
patients whose civil condition was known, sixty-one and ninety-c 
hundredths were single, twenty -nine and fifty-eight one hundredths 
married, and eight and fifty-one one hundredths were widowed. 

It appears from the census of eighteen hundred and fifty-one i 
the condition of the entire population of Great Britain (aged twe 
and upwards) was in respect of marriage as follows: * 



Unmarried. 


Married. 


"Widowed. 


Totals. 


3,456,310 
30.2 


6,852,695 
57.6 


1,178,559 
10.2 


11,487,664 
100 



The greater liability of single than of married persons to insanity is 
explained in part by the fact that a much larger proj)ortion of the 
unbalanced, odd, idle, worthless, restless, dissipated, and improvident 
do not marry. The causes of their celibacy and insanity are radically 
the same. We know that marriage often leads to insanity; domestic 
troubles and afflictions, and all cases of puerperal insanity being the 
most prominent. Yet, on the other hand, it seems to prevent a much 
larger number of cases than it produces. The kindly and calming 
influences of the domestic circle, the greater regularity of habits, the 
freedom from inordinate passions and dissipated tendencies, all have 
their due effects in keeping the mind in a proper state of equilibrium, 
which is sanity. 

It further appears from the foregoing table that while the greatest 
numbers and largest proportions of the insane are among the single and 
the smallest among the married population, that the widowed occupy an 
intermediate proportion, thus proving conclusively that marriage is one 
of the most powerful agencies in preventing the increase of this dread- 
ful malady. 



CHAPTEE Y. 



INFLUENCE OE SOCIAL DISTINCTIONS. 

Diseases of the brain are peculiar to no class in society. They are 
found in all ranks of men — the high and the low, the refined and the 
vulgar, the educated and the ignorant, the rich and the poor — but not in 
the same proportion in all classes. The brain is not the mind, but the 
organ through which it operates and through which it manifests itself. 
There are manifold causes and various conditions by which it is dis- 
turbed. Many and various events and external circumstances; many 
conditions of the body and nervous system affect this organ morbidly. 
These pervert its functions, and produce mental disorder. These disturb- 
ing causes are distributed in various proportions among the different 
classes of society; none are entirely free. Some causes are common to 

* See Bucknill & Tuke on Insanity, p. 255. 

7 




50 

Len, and others are the especial dangers that hover over 
several classes. The distinctions in society are manifest 
(e, but not more certain than the variety of dangers that 
.lental health. 

/condition of man, that has been fixed upon him from the 
^s the necessity of protection and sustenance, and his first 
Action is his desire to obtain them. To some the means of 
lG easily. Their sagacity, industry, and faithfulness procure 
lot only what they need, but enable them to create a surplus 
for future emergencies and for more expensive and luxurious 
All of these have a competence, and some have great wealth, 
fear of want. These constitute the higher, but by no means the 
class of society. Another and larger class, with less mental and 
power or opportunity, obtain what they need from day to day, 
4ave thrift enough to secure the means of meeting the ordinary 
os of life and the necessities of sickness and age when they cease to 
or. A third and very large class in every country, called the labor- 
/g class, not because they work more than the others, but because, hav- 
ing no capital, they obtain their subsistence by the labor of their hands 
exclusively. They earn from day to day what they consume, and lie 
down at night no richer than they were in the morning. They sustain 
themselves as long as strength lasts, but when sickness overtakes them 
or old age falls upon them, having accumulated no capital to fall back 
upon they become dependent upon the charity of friends or public 
bounty for support. 

Below these in the social scale are the entirely dependent or pauper 
class, who are housed, fed, and clothed by the general treasury. These 
are found most numerous in old and least so in new countries. All of 
these classes are subject, though in different degrees, to insanity. Beside 
the courses of mental disorder that are common to all, some appear more 
frequently and act with more destructive power on some classes, while 
they are rarely known in others. As a general law the most favored 
class have the best natural endowments of body and mind, the best 
physical health, the best mental and moral training and discipline. 
These give them their position and enable them to sustain themselves 
therein, Their wisdom and sagacity, their power of consideration and 
of adapting means to the desired ends, their faithfulness to the law of 
their being, and discreet self management, insure this prosperity and 
the world's confidence. , 

Fortune is not the blind goddess as commonly represented, scattering 
her favors without regard to conditions and circumstances, making some 
rich who never sought for her blessings, and others poor in spite of their 
well laid plans and earnest endeavors. As a rule, accident and chance 
have but little to do with this matter. Success is almost always the 
result of fitting plans and faithful execution. " Herein is wisdom justi- 
fied of her children, and folly may make a similar boast, the child is 
after the similitude of the parent." The wisdom may be merely of this 
world, and applied to a narrow field wherein riches are gathered, or one 
wherein the flowers of fashion bloom. It may be a better wisdom that 
leads to self culture, to learning, to the generous and peaceful graces of 
character. Whatever it may be, it is sufficient for its purpose. Without 
this wisdom of the appropriate kind no man attains to his desired ends. 
A man may be a fool in everything else, but he is neither foolish nor 
weak in that in which he succeeds. Success in any line of life is then 



51 

evidence of wisdom appropriate to that purpose, and of strength, suffi- 
cient for its accomplishment. 

The simple fact that men are in the higher social ranks of culture, 
character, or wealth, must be accepted as prima facie evidence that they 
have good minds, well developed, trained, and balanced; that they have 
strength and discipline of character by which they reached their present 
position and retained themselves in it. Being generally persons of good 
health and sound mind they have in themselves better defences against 
insanity than the lower classes that are less liberally endowed and less 
favored by education and self discipline. Nevertheless, the more favored 
and prosperous classes have their peculiar dangers that threaten their 
soundness of mind. Here, temptations to excessive mental labor in 
business, study, in the pursuit of riches and knowledge, ambitious pro- 
jects and political strife, all have their influence. In this country, where 
no child is bound to follow the paths of his father, where all the avenues 
to wealth and distinction are oj^en to any who desire to enter, and the 
race of life is free to every competitor, whatever may be his history and 
preparation, there are some in every rank who are struggling with all 
their energy to grasp what is almost within or even beyond their reach. 
Some of these who succeed find themselves in a false position, which 
they are not prepared to fill, and are compelled still to fight the battle to 
sustain themselves in form and appearance, for which they were no: 
educated. In this class are the dangers of great reverses in business, oi" 
graceful and fashionable dissipation, and sometimes of gross sensuality ; 
of disregard to the natural laws of health, in late and unusual hours, 
unreasonable eating, inadequate costume, etc-. All these tend to over- 
work or disturb the brain, and sometimes the mind is disordered an i 
insanity follows. 

The class next below the highest, just described, is composed of per- 
sons of comparatively limited fortune. They have less strain upon their 
mental powers. Generally they have a more even course of life, and 
are more contented with their position; their moderate gains meet all 
their necessities and secure them against suffering in days of sickness 
and age; yet there are those among them who are earnestly striving to 
rise to the higher place, and whose ambition lays too heavy a tax on 
their physical and mental energies. Some break down under this un- 
natural strain upon their powers. In this class there is less waste o." 
health and force, in graceful dissipation than in the class above them, 
and in coarse and vulgar dissipation than in the classes below. These 
have fewer causes of insanity peculiar to themselves than either of the 
other classes; and though they furnish the smallest number of victims 
to this disorder, yet they have their dangers, under which some of their 
members lose their mental health. 

The poor have not been wanting among mankind from the earliest 
records; nor until the human constitution, with the natural passions and 
appetites, shall be changed, and men and women conform their habits to 
the laws of health and restrain their self-indulgence, will the poor fail to 
appear in every successive generation. 

In the world's careless estimation, poverty is simply an absence of the 
outward means of life, food, clothing, shelter, and the real and appar- 
ently sufficient way of relief is to supply these wants or give their value 
in money. This is but a superficial view of this matter. Poverty is 
deeper and earlier than present ascertained destitution. It is in a groat 
measure an original element in the man; in his constitution; in his devel- 
opment and education, and in his character. 



52 

This class is filled from causes opposite to those that fill the highest 
class. The primary grounds of prosperity, sagacity, coordinating 
power, physical strength, industry, perseverance, self-discipline, are defi- 
cient in the poor. As a class, they have less health and intellectual 
force; less perfect development and education. More of them are of 
unbalanced mind, of unreliable judgment; they are more changeable in 
purpose; their plans are less in harmony with their circumstances and 
the means at their control, or their power of execution. Here are found 
more of the victims of low and gross dissipation — the intemperate, the 
debauched; more of those who suffer from hereditary diseases. 

The members of this class are generally laborers for wages, and a large 
proportion are unskilled, doing the work that simply requires muscular 
force with the least mental exertion. They earn a bare subsistence 
while in health, with little or no surplus to depend upon in sickness and 
old age. They exemplify the old law, that " from him that hath not 
shall be taken, even that which he hath." One element of poverty 
begets another, and this creates a third, and still others follow, until the 
low condition of the man, without and within, is complete. As his earn- 
ings are small his nutrition is meagre, clothing inadequate, dwelling nar- 
row and unhealthy. He must live with his family in small and unven- 
tilated rooms, and breathe impure air; his frame, therefore, is not 
strengthened; his brain is inactive, his mind cloudy; he must conse- 
quently accept the coarsest work for the lowest wages, that afford no 
means of strengthening his body or elevating his mind to the power of 
more profitable Jabor. Depressed, languid, torpid, he often seeks relief 
in artificial stimulants, and adds another fountain from which poverty 
flows. His hard and exhausting toils destroy his buoyancy of spirit, 
take away his hope, and neutralize his ambition to rise to a better scale 
of life. 

From the original and constitutional character of the poor, and from 
their habits and exposure, there is much insanity among them. Poverty 
and insanity often spring from the same source. Persons who are weak 
in intellect, undisciplined, unbalanced, fickle, or excitable, are wanting in 
the elements of success, and are poor for this reason. Their mental and 
moral condition are the sources of much insanity. Their imperfections 
or perversities grow into mental disorder. These are not insane because 
of their destitution, nor yet poor because of their insanity; but they are 
both because they have in their brains the elements of poverty and 
mental disorder. So, also, intemperance and other sensual indulgences 
creates the double destruction of estate and mental health. Drunken- 
ness is one of the most fruitful causes both of insanity and pauperism. 

The paupers, the lowest in the social scale, have still more the ele- 
ments of weakness. There are among them more than among others 
defective and disordered constitutions; more diseases both of body and 
mind. In some, their disability, original or acquired, was manifest; 
others have been weighed in the world's balance of business or labor of 
some kind and found wanting. The deficiencies and perversities of the 
previous class (the poor but independent laborers) are intensified in this. 
At least the paupers live nearer the borders of insanity than others, and 
a much larger portion pass that bound into lunacy. Beside these causes 
inherent in and acting on the dependant class to produce insanity, they 
receive a large supply of recruits from the other and more favored 
classes on account of mental disorder. Some men, sufiiciently secure in 
their self sustaining power, by their skill and exertions supply all their 
wants until they lose their reason, when labor, and production, and 



53 

income cease together. If the mental disorder be not relieved, and life- 
long insanity be established, the accumulated capital will soon be 
exhausted, and the patient and his family fall upon the public treasury 
for support. 

In some cases the family may yet have power to support themselves, 
especially if the lunatic be not the head and principal producer, but can- 
not add to this the board and care of the patient. Then they throw him 
upon the town or State, and join him to the pauper class, while the rest 
of the family remain in the ranks of the independent. These last 
described are not made insane by their poverty, but their insanity made 
them paupers. In this way insanity hangs about the necks of its vic- 
tims in all the social ranks, depriving them of the power of production, 
and consuming an undue proportion of the family substance. Under this 
burden they gravitate downward, and may ultimately reach the lowest 
depths of pauperism. Another and important fact is discovered; that a 
very large portion of the lunatics in the pauper class are chronic cases, 
who have been a long time disordered, and whose day of healing is past, 
and whose malady will end only in death. 

From all these and manifold other causes the proportion of insanity 
among the paupers is very great as compared with that of the higher 
ranks, and indeed with all the independent classes of society. 

The annual reports of the Commissioners in Lunacy for England show 
the number of lunatics in the independent classes and among the paupers. 
From these and other British reports on population and on the poor the 
following facts as to numbers are derived, and the proportion of lunatics 
in the classes are calculated from these facts: 

During the ten years, eighteen hundred and sixty-two to eighteen hun- 
dred and seventy-one, the average annual independent population was 
twenty million three hundred and thirty-eight thousand seven hundred 
and ninety -two. The average annual number of independent lunatics 
was five thousand nine hundred and seventy-three. The ratio of luna- 
tics in this class was one in three thousand four hundred and five. The 
average annual number of paupers was one million twenty-one thousand 
eight hundred and seventy -two. The average annual number of pauper 
lunatics was forty -two thousand seven hundred and sixty-four. The 
ratio of lunatics in this class was one in twenty-four. The proportionate 
ratios of lunatics to their respective classes were three thousand four 
hundred and five to twenty-four, or one hundred and forty-two times as 
great in the pauper as in the independent classes of English society. 

The pauper lunatics are in the asylums and workhouses, or are other- 
wise subject to official supervision — their numbers therefore are known 
and accurately stated. The independent lunatics are in the public and 
private asylums and hospitals, and under the guardianship of the State, 
through the Lord Chancellor and his agents, and under the observations 
of the Commissioners in Lunacy; but there may be others not known to 
these authorities who are kept at their homes or privately boarded else- 
where. These are not included in this statement of the independent 
insane. But the number of these who have escaped the vigilant inqui- 
ries of the Government officials cannot be very great; admitting, how- 
ever, that there were as many as were revealed and reported or even 
three or four times as many, still the differences of the burden of lunacy 
resting on the pauper class is enormous in comparison with that which 
the more favored classes are doomed to suffer. 

There was a similar disproportion of insanity in the pauper and inde- 
pendent classes of Massachusetts, as shown by the report of the Com- 



54 

missioners in eighteen hundred and fifty -four, and it is probable that the 
same exists in every civilized country. 

Unfortunately, we have no means of showing this in the United 
States and most other countries, though the accompanying table shows 
that they constitute a majority of the insane in Scotland, Ireland, and 
Belgium, as well as in England, notwithstanding the proportion of the 
pauper population would not exceed a twentieth of the whole in any of 
these countries: 



COUNTKY. 



Population. 



o 



po 

P-> 

M 

Bi 
o* 



$0 



P 

P-i 

M 

o" 



Proportion of— 



V CO 

SO p 

CD CD 

2 so 

(3 3 



p^ 



&J 



Ojl— I 

o -• 



►d 

p'm 
§2 



p 

3 
Pj 
I— ( 

o* 



England 
Scotland 
Ireland. 
Belgium. 

Total . 



22,090,163 

3,222,837 
5.195,236 
4,984,451 



54,713 
9,571 

17,194 
7,431 



48,433 
6,276 
9,498 

3,852 



88 per cent 
65 per cent 
55 per cent 
52 per cent 



lin 456 
lin 513 
lin 546 
1 in 1294 



35,492,687 



88,909 



68,059 



76 per cent 



1 in 521 



It has been explained elsewhere and must not be overlooked, however, 
that a large majority of these pauper lunatics are no more furnished by 
the pauper element in society in these countries than are the non-paying 
patients in our own institutions; most of them were self-sustaining and 
independent citizens till misfortune assailed them and deprived them of 
their reason and the power to labor. Yet all must admit that pauperism 
is one of the most prolific sources from which insanity is supplied. Here 
is a grave question for the consideration of those in authority, whether 
they may not, by providing means sufficient to accommodate and care 
for every one who becomes insane, thereby affording proper treatment 
in the early stages of the disease, restore most of these unfortunate 
victims of this direful malady to health, the power to serve themselves, 
their families, and the State, and whether this is not a duty which every 
commonwealth owes to itself and to its members? 



CHAPTEE VI. 

APPARENT INCREASE OF INSANITY. 



For many years it has been apprehended that this fearful malady was 
increasing, not only in our own country, but in all other civilized 



55 

nations; land as early as eighteen hundred and fifty-one Doctor Ja±'' 
read a paper on the subject before the Association of Medical Superin 
tendents of American Institutions for the Insane, in which he said: "It 
is a recent thing that any nation has enumerated its insane, and I cannot 
discover that any nation has ascertained and reported this twice, and 
thus offered us data for the comparison." 

Since tkat-time other nations have taken an account of their insane, 
and some of them several times, but only to prove that insanity has 
increased, at least apparently, and in some countries very rapidly, within 
comparatively a short time. Thus the following table, from official 
reports, will show the result in the countries named: 

UNITED STATES — TWENTY YEARS. 



Year. 


Population. 

« 


X amber 

of Insane and 

Idiots. 


Eatio per 1,000 
to _ 
Population. 


Proportion 
to Population. 


1850 
1860 
1870 


23,191,876 
31,443,322 

38,555,983 


31,397 

42,864 
61,909 


1.35 
1.36 
1.60 


1 in 738 
1 in 733 
1 in 623 




e>; 


GLAND — TEN YI 


,ARS. 




1862 
1865 
1868 
1871 


20,336,467 
20,990,946 
21,649,377 
22,704,108 


41,129 
45,950 
51,000 
56,755 


2.02 
2.18 
2.35" 
2.49 


1 in 494 
1 in 456 
1 in 424 
1 in 400 



\ 



SCOTLAND TEN YEARS. 



1862 


3,083,989 


6,341 


2.05 


1 in 486 


1865 


3,136,057 


6,468 


2.06 


1 in 484 


1868 


3,188,125 


6,931 


2.17 


1 in 459 


1871 


3,358,613 


7.808 


2.32 


1 in 430 



IRELAND — NINETEEN YEARS. 



1851 


6,552,385 


15,098 


2.0a 


1 in 434 


1856 


6,164,171 


14,141 


2.29 


1 in 435 


1861 


5,798,967 


16,749 


2.88 


1 in 346 


1870 


5,195,236 


17,194 


3.39 


1 in 303 



56 



FRANCE — FIFTEEN YEARS. 



1851 

1866 



35,783,170 
37.988,905 




1 in 795 
1 in 418 



This shows that the ratio of insane and idiots per one thousand in the 
United States in eighteen hundred and fifty was one and thirty-five one 
hundredths, or one in seven hundred and eight, and in eighteen hundred 
and seventy, one and sixty one hundredths, or one in six hundred and 
twenty-three. 

In England, in eighteen hundred and sixty -two, it was two and two 
one hundredths, or one in four hundred and ninety-four, and in eighteen 
hundred and seventy-one, two and forty-nine one hundredths, or one in 
four hundred. In Scotland, in eighteen hundred and sixty-two, it was 
two and five one hundredths, or one in four hundred and eighty-six, and 
in eighteen hundred and seventy-one, two and thirty -two one hundredths, 
or one in four hundred and thirty. In Ireland, in eighteen hundred and 
fifty-one, it was two and thirty one hundredths, or one in four hundred 
and thirty-four, and in eighteen hundred and seventy-one, three and 
thirty -nine one hundredths, or one in three hundred and two. In France, 
in eighteen hundred and fifty-one, it was one and twenty -five one hun- 
dredths, or one in seven hundred and ninety-five, and in eighteen hun- 
dred and sixty-six, two and thirty-eight one hundredths, or one in four 
hundred and eighteen. 

But even these statements must not be taken as altogether correct. 
In the paper of Doctor Jarvis, already referred to, he shows how very 
carelessly the returns from France had been made, and so it may have 
been with those from which our figures were taken : Statistique de la 
France, 1866, second series, Yol. XVII. In the United States we have 
also shown that all of the insane and idiots have probably not been 
found. In England, Scotland, and Ireland, the reports are mainly 
official, showing the number in institutions for custody and cure, in pau- 
per establishments where they are kept merely for support, and those 
under the guardianship of the Lord Chancellor's Commissioners. 

It is probable there are many others who belong to neither of these 
categories. Nor must these facts induce the conclusion that insanity, if 
it has increased at all, has done so in anything like the proportion here 
indicated. The existence of a fact and our knowledge of it are two 
very different things. Electricity has existed for all time, but our 
knowledge of its properties and the purposes to which it may be use- 
fully applied is of very recent date. So it may be in many respects 
with our knowledge of the insane. We have already shown that many 
had existence in Massachusetts who could not or had not been found by 
one set of Commissioners who were found by another Commission whose 
method of search was different and whose work was more thorough. 
Nor must it be overlooked that since greater attention has been paid to 
the insane than formerly many more are brought to light and seek the 
benefit of asylum accommodation. Add to this the important fact that 
the duration of life among the chronic insane has been much increased 
by the greater amount of care and the more humane treatment which 
they receive, and we can readily account for at least a portion of the 
apparent increase. 



57 

It is exceedingly interesting to trace this apparent increase of insanity 
in the various countries of the world, and easy to show how much more 
rapidly the increase has been brought to light in those countries where 
the most humane and liberal provisions have been made for their accom- 
modation. We will show, however, that it is not confined to the present 
epoch, nor to any particular country; but that it has always and every- 
where come forth from its recesses and hiding places whenever suitable 
hospitals for the reception of its victims were provided. Thus Bucknill 
& Tuke state that " in the short space of nineteen years the estimated 
proportion of the insane in England rose from one in seven thousand 
two hundred to one in seven hundred and sixty-nine;" while on the 
first of January, eighteen hundred and seventy-one, there was one to 
four hundred. This is simply insanity revealed by increased attention. 

The following extracts from the paper of Dr. Jarvis on this subject 
will show the results in several States and countries at a former period: 

" Thus we find that whenever the seeds of this interest are once sown 
and allowed to germinate and grow, it spreads continually thereafter. 
Whenever the attention of the people of any country is called to this 
subject, and a hospital is built, there follows a remarkable increase of 
the cases of insanity revealed to the public eye and asking for admis- 
sion. 

" In the year eighteen hundred and thirty-two, when the McLean 
Asylum at Somerville, Massachusetts, contained sixty-four patients, the 
State Lunatic Hospital was established at Worcester for one hundred 
and twenty patients. This was as large a number as was then supposed 
would need its accommodation. In eighteen hundred and thirty-six one 
new wing, and in eighteen hundred and thirty-seven another new wing, 
and rooms for one hundred more patients were added to the Worcester 
Hospital, and at the same time the McLean Asylum contained ninety- 
three lunatic inmates. In eighteen hundred and forty-two the Worces- 
ter Hospital was again enlarged by the addition of two new wings, and 
now these are all filled to overflowing, having four hundred and fifty 
patients in May, eighteen hundred and fifty-one, while at the same time 
there were two hundred at the McLean Asylum, two hundred and four 
at the City Lunatic Hospital at Boston, and one hundred and fifteen in 
the county receptacles for the insane at Cambridge and Ipswich, beside 
thirty-six in the jails; making one thousand and fifteen lunatics in the 
public establishments of Massachusetts in eighteen hundred and fifty- 
one, instead of the one hundred and eighty-two which were there in 
eighteen hundred and thirty-two " — an increase of eight hundred and 
thirty-three in nineteen years. 

" Besides these there is now a great demand for the admission of 
patients who cannot be accommodated in these establishments already 
built, and there is so much interest elicited in their behalf, and the 
friends of the lunatics are so alive to the necessity of providing means 
of relief for all of these sufferers, that the Legislature has just now 
authorized the erection of a new hospital sufficiently large to receive 
two hundred and fifty patients. 

" The State Hospital at Augusta, Maine, was opened in December, 
eighteen hundred and forty, with only thirty patients. In eighteen 
hundred and forty -five it was so crowded that the Trustees asked for 
more rooms. In eighteen hundred and forty-seven the building was 
enlarged, and one hundred and twenty-eight patients were admitted. 

8 



58 

In eighteen hundred and forty-eight the house was all filled, and more 
were offered than could be accommodated, and the Superintendent asked 
the Legislature to build still another wing, to enable him to meet the 
increased demand. 

" The New Hampshire Hospital was opened in eighteen hundred and 
forty -two, and received twenty -two patients; these were all that were 
offered. In eighteen hundred and forty-three these were increased to 
forty-one ; in another year, eighteen hundred and forty-four, there were 
seventy; in eighteen hundred and forty-five there were seventy-six; in 
eighteen hundred and forty-six there were ninety-eight; and in eighteen 
hundred and fifty they reached the number of one hundred and twenty. 
In the meantime additions have been made to meet this growing demand 
for more and more accommodations. 

" The number of patients in the Eastern Virginia Asylum at Williams- 
burgh has increased more than two hundred per cent in fifteen years — 
from sixty in eighteen hundred and thirty-six, to one hundred and 
ninety -three in eighteen hundred and fifty. 

" Those in the Western Virginia Asylum at Staunton, have increased 
more than eight hundred per cent in twenty-three years — from thirty- 
eight in eighteen hundred and twenty-eight, to three hundred and forty- 
eight in eighteen hundred and fifty. 

" The average number of patients in the Ohio State Lunatic Asylum at 
Columbus, was sixty-four in eighteen hundred and thirty-nine, and three 
hundred and twenty-eight in eighteen hundred and fifty — being an 
increase of more than four hundred per cent in eleven years. 

u JSTow, no one would imagine that the population of these several States 
has increased in these ratios of the increase of the lunatics in their asy- 
lums within these respective periods. But it will readily be supposed 
that the opening of these establishments for the cure or the protection 
of lunatics, the spread of their reports, the extension of the knowledge 
of their character, power, and usefulness by the means of the patients 
that they protect and cure, have created and continue to create more 
and more interest in the subject of insanity and more confidence in its 
curability. Consequently, more and more persons and families who, or 
such as who formerly kept their insane friends and relations at home, or 
allowed them to stroll abroad about the streets or country, now believe 
that the'y can be restored or improved, or at least made more comforta- 
ble in these public institutions, and therefore they send their patients to 
these asylums and thus swell the lists of their inmates. 

" For the same reason the people in the vicinity of lunatic hospitals 
send more patients to them than those at a greater distance. Thus the 
County of Worcester, Massachusetts, has sent one lunatic out of every 
one hundred and sixteen of its population, while the most remote coun- 
ties of the State have sent only one in three hundred and sixty-one of 
their people to the State Hospital since its first establishment. 

V. In New York, the County of Oneida has sent one in three hundred 
and sixty-one, and the remotest counties sent only one in fifteen hun- 
dred and twenty -three of their people to the State Lunatic Asylum at 
Utica. 

" In Kentucky, the people of Fayette County sent one in eighty-nine of 
their people to the Lunatic Hospital at Lexington, while the farthest 
counties sent only one in sixteen hundred and thirty-five of their popu- 
lation to that institution. 

"Similar differences in the use of the public hospital are found in 






59 

Maine, New Hampshire, Connecticut, Ohio, Maryland, Tennessee; and 
doubtless in other States the same will be found on investigation. 

" To infer the number of lunatics in the community from the number in 
the hospitals is about as unsafe as to infer the number of births from 
the number of children in the schools. The first element here is want- 
ing: that is, the proportion of all the children that are sent to school. 
Now, as this is very different in Massachusetts and England, and Spain 
and Egypt, no reasonable man would venture to compare the number of 
births in these several countries by the population of their school 
houses. The provision for the cure and custody of the insane in these 
countries differs as widely as their provision for the education of child- 
ren; and yet writers have given us the comparative numbers on this 
ground, as in London one in two hundred, because there were seven 
thousand in the metropolitan hospitals, and in Cairo one in thirty thou- 
sand seven hundred and fourteen, because there were fourteen in the 
hospitals of that city. 

" It must be further considered that many of these statements that 
were put forth as positive facts are given in such round numbers as to 
afford good reason for supposing that they or their elements are esti- 
mates rather than actual enumerations. 

" Thus, in some works on this subject, there are stated to be thirty-two 
thousand lunatics in France; sixteen thousand in the United States; 
seven thousand in London; four thousand in Paris; two thousand in 
Pennsylvania, and one thousand in Massachusetts. Millingen says the 
proportion of lunatics to the people is one in one thousand in England, 
and in France one in one thousand. 

" One department in France, Ariege, gives three hundred vagabond 
lunatics for four successive years, without change, but these suddenly, 
in the fifth year, diminish to two hundred and fifty, and in the seventh 
year disappear entirely. Another department, Seine Inferieure, reports 
two hundred lunatics for seven successive years, and another three hun- 
dred for three successive years in private families. Saone Haute reports 
none, either in private families or as vagabonds, for two years, when 
suddenly in one year there appears to be one hundred and ninety-three. 
Sarthe reports two hundred and seventy-three lunatics in families in 
eighteen hundred and thirty- seven, and then they all disappear and are 
reported no more. Mayence reports eight in families and as vagabonds 
in eighteen hundred and thirty-five. These are increased to two hun- 
dred and nine in eighteen hundred and thirty-seven, and diminished to 
twenty-one in eighteen hundred and thirty-eight, and to eight, the 
original reported number, in eighteen hundred and forty-one. There 
are so many of these apparent inaccuracies, such full and round num- 
bers, and such unvarying totals where there must be some change, and 
such sudden and violent changes, out of all relation to the ordinary cir- 
cumstances of society, that we are compelled to look with distrust upon 
the whole, and consider it as but little better than mere guess work, 
with more or less foundation in fact." 

As more attention has been paid to the insane within the last twenty- 
five .years than ever before, we may fairly conclude that their numbers 
have been more accurately ascertained and reported, at least in some 
countries. The foregoing extracts prove how rapidly this malady 
appeared to increase prior to eighteen hundred and fifty -two in all the 
States and countries where liberal provision had been made for its 
proper treatment. We have shown its increase in England and the 



60 

United States since that time, and the Chapter on insanity in France 
affords a comprehensive view of the disorder in that country. But let 
us see what has been the result in the several States and Territories of 
the United States, respectively, within the last twenty years. The fol- 
lowing table shows the population, the number of the insane, the num- 
ber of idiots, and the ratio of each to the total population, in eighteen 
hundred and fifty, eighteen hundred and sixty, and eighteen hundred 
and seventy. It will be observed that the ratio of the insane has 
increased from one in fourteen hundred and eighty -five to one in thir- 
teen hundred and ten during the first period of ten years, and to one 
in ten hundred and thirty-one in eighteen hundred and seventy; while 
during the whole period of twenty years the idiots are not so numerous 
in proportion as they were in eighteen hundred and fifty, being at that 
time in ratio of one in fourteen hundred and seventy-six, and in eighteen 
hundred and seventy, one to fifteen hundred and seventy-one. We have 
neither time nor space to analyze each State separately, but the curious 
can do so for themselves, as the facts appear in the tables. 



TA.BLE S. 



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66 



Table, 



Showing the Population, with numbers and proportions of Insane and Idiots, 
Classified according to Race, in the United States in 1870. 



EACE. 


Population. 


Insane. 


Idiotic. 


Em 

© » 
• CD 


s-g. 

hjo" 

us 

»8 52LI 

PI 


SO o 
B <n- 

^© 

3*M 
: S 9 

: » 

• CD 


Ratio of Insane 
and Idiotic to 
Population. . . 


Whites 


33,586,989 

4,880,009 

62,254 

25,731 


35,560 

1,774 

35 

13 


21,324 

3,188 

5 

10 


1 to 944 
1 to 2,750 


lto 1,579 
1 to 1.530 


56,884 

4,862 

40 

23 


1 to 590 


Colored 


1 to 983 


Chinese 


1 to 1,807 1 to 12,450 
1 to 1,979 1 t,n 2.IY73 


1 to 1,556 
1 to 1,118 











Nevada will of course come out with flying colors, since all of the 
insane of that State, with two exceptions, have been credited to us. As 
the table shows a larger proportion of the insane to population in the 
District of Columbia than in almost any other community in the world — - 
being one to two hundred and forty-eight — we deem it not only just, but 
proper, to show why this is so. The Government Asylum, located in 
the District, is not only intended for those who reside within its limits, 
but also for the soldiers and sailors of the army and navy of the United 
States; and as these are brought from all parts of the Union, of course 
the list is swelled far beyond the ordinary proportion in other communi- 
ties. The causes leading to the rapid development of insanity in this 
State will be considered in relation to other matters pertaining to Cali- 
fornia. 



CHAPTER VII. 



INSANITY IN FRANCE— GENERAL STATISTICS OF THE INSANE FROM 
1854 TO 1866— DR. MOTET'S ANALYSIS OF LEGOYT'S WORK. 



Having alluded in the preceding Chapter to the imperfect maimer in 
which the insane in France had been enumerated, even at so late a date 
as eighteen hundred and fifty, we take pleasure in laying before our 
readers the following able and interesting analysis of M. Legoyt's great 
work oh the Statistics of the Insane, by Dr. Motet, Secretary of the 
Medico-Psychological Society of France, who kindly presented us with a 
copy. 

This able review of one of the most important public documents ever 
published in France cannot fail to interest and instruct all who read it. 
We believe it gives a better idea and affords a more comprehensive view 
of the number and condition of the insane in France than any work that 
has hitherto been offered in the English language; and though it treats 
of some topics upon which we have already touched it is given entire: 



67 

DR. MOTET'S ANALYSIS OF LEGOYT'S WORK.* 

The subject of insanity has for some time actively interested the 
French mind. People are now no longer satisfied with barren sympathy ; 
they question, they are anxious. Each one imagines it his right and his 
duty to probe this deep wound of society, and doubtless with a laudable, 
but sometimes inopportune zeal, reforms are proposed on all sides; an 
almost radical modification of the legislation which here regulates the 
condition of the insane is desired. A word which in our country is 
never uttered without exciting a tumult — liberty — is the watchword at 
which rally a great number of writers who lack only one thing, a little 
experience. To these publicists who are animated by the best inten- 
tions, we will not reply by cold disdain. We have remarked elsewhere f 
and we gladly repeat it here, generous illusions are deserving respect; 
everything which relates -to insanity acquires a dignity, a magnitude 
just in proportion to this measureless misfortune, and those who, excited 
by a deep sympathy, demand of us by what right we violently separate 
from society a being whose reason is affected, deserve to be answered 
not merely by denying their competence, but by arguments and facts of 
a nature to justify our conduct. 

Moreover, the time has passed when knowledge was an exclusive 
monopoly in the hands of a few. Social problems are debated in open 
day. We cannot stay the movement of thought, which, after all, tends 
toward progress; and to be silent will be to expose ourselves to deserve 
the reproach which, from habit, is still easily enough addressed to us, of 
seeing nothing beyond a narrow specialty. It would be a singular incon- 
sistency for us to refuse to examine the elements of an investigation 
which every one may possess. The Moniteur of April 16, 1866, published 
a report of the Minister of Commerce, the impression of which cannot 
yet have been effaced. These figures, which seem to increase each year, 
and which statistics present from time to time to the impatient but legiti- 
mate curiosity of economists and philanthropists, need to be commented 
on and discussed; what is of especial importance is to give them a correct 
interpretation, and, accepting them as the stern expression of facts unfor- 
tunately too true, not to force results from them — not to deduce too 
hasty, and therefore, very probably, erroneous conclusions from them. 
Many minds, even the best, accepting them without question, and seduced 
by their eloquence (the expression is restricted to a particular signifi- 
cation), imagine it their duty to take up arms against us. Although 
silence sometimes serves a just cause better than too much discussion, it 
seems to us that we ought not to be silent to-day. We have at our com- 
mand the elements which are always wanting to those who can only 
make abstracts of accounts. Is it that we consider fruitless those patient 
investigations which present to us, at stated periods, the balance of our 
intellectual and moral condition? Such is not our idea. We well know 
(for we have been aided by it) what labor and research have been 
necessary to present at once the imposing array of figures which consti- 
tutes the statistics of the insane in France from 1854 to 1860. M. Legoyt 
possesses a thorough experience in these matters, and we are merely 
just in tendering to him here the tribute of praise which he deserves: 

* Translated by Miss Martha W. Sawyer, Harrison Square, Massachusetts. 

t Of the possibility and propriety of allowing certain classes of insane to leave special 
asylums and of placing them either at agricultural improvement or with their own families. 
(Medical Congress at Lyons, 1864); (The Insane before the Law). Paris, 1866. 



68 

he has well completed a thankless task, the scattered materials for which 
would have remained in confusion if he had not collected them, substi- 
tuting in place of chaos a fruitful harmony. It is not, then, a criticism 
which we are about to make; it is a complement of instruction which 
we would present. To harsh figures we would oppose facts; what seems 
to us important is to explain how results, apparently deplorable, are due 
to the influence of causes very readily appreciable; in short, to solve a 
question which has been put to us, and which, in our opinion, will place 
us in a most humiliating situation if we leave it unanswered. 

The sequestration of the insane in public or private asylums is, at the 
same time, a measure of public order and of personal safety. The lunatic 
is a sick person who has the right, by very reason of the special disease 
with which he is affected, to special care; he is also a being dangerous 
to those around him; in presence of this terrible scourge, the most pre- 
possessed minds cannot refuse to admit it, family devotion is, for the 
most part, fruitless; they are exhausted by vain efforts; the most gen- 
erous sacrifices result only in cruel deception; they are obliged, sooner 
or later, to adopt the serious measure of placing in an asylum the patient 
whom they can neither protect nor take care of at home. We under- 
stand too well how serious are the questions which sequestration in- 
volves, even when it is most justifiable, to seek always to hasten it. 
Although cure is a performance too often compromised by unwise delay, 
we are but feebly disposed to blame the family affection which resists 
our advice and waits until the last moment to take leave; but we do not 
hesitate to blame those who entertain unjust suspicions and represent 
the asylum as the sepulchre of intelligence. It is too lightly flinging 
the shroud over the head of the dying; it is too seriously undervalueing 
the wisdom and the honor of the physicians who devote themselves to a 
task always sad. The lunatic is not fatally condemned to leave the little 
reason which still remains in those establishments which the vivid imag- 
inations of some philanthropists transform into a kind of extinguisher. 
There is something better to be done than to address petitions to the 
Senate; it is necessary to f^ive an account of things, not to seize, with 
unreflecting haste, the malicious lucubrations of unfortunate minds still 
affected, although they may present the fairest appearance. But to 
restrain impulse in France would be to reform our national character, 
and although these excesses may not be to our taste, they have, as a 
point of departure, a sentiment so elevated as to merit being reduced to 
their just value without passion on our part; we have, moreover, good 
reasons enough to produce to maintain, without fear, an attitude of 
defense, and never to attempt to assume an aggressive attitude towards 
those who try to save, by a bold coup de main, their compromised cause. 
"We shall proceed in this matter in a calmer way, consulting rather the 
experience of our predecessors than our own; but, nevertheless, we do 
not wish to be hastily accused, or to have it thought that we have gained 
nothing during thirty years. m We do not think, whatever may be said, 
that we are behind neighboring nations; our legislation, if it is not per- 
fect, does not deserve the reproach which it receives, of being, the greater 
part of the time, insufficient or arbitrary. One cannot deny, without 
systematically closing his eyes to evidence, that nowhere is the solicitude 
of the State, of the Government, more active than in our country. We 
find a proof in these statements which we now possess, and which we 
wish to explain to all. We have been preceded in this design by our 
learned colleague, Dr. Brierre de Boismont, who published in this collec- 



69 

tion an excellent analysis of the statistical works of M. Legoyt.* We 
cannot do better than to follow his steps; finding ourselves, moreover, 
in perfect conformity with his views, we shall be obliged to refer to 
points already noticed by him. 

The number of establishments, pnblic and private, devoted to the 
insane was one hundred and eleven in eighteen hundred and fifty -three. 
At the close of eighteen hundred and sixty there were only ninety -nine, 
as several of them may have been suppressed on account of their trifling 
importance or of their incomplete or irregular organization. On the 
first of January, eighteen hundred and fifty-four, their population was 
twenty-four thousand five hundred and twenty-four lunatics of both 
sexes. This number increased in the succeeding years, but the progres- 
sion has been much less rapid than in the period between eighteen hun- 
dred and thirty-five and eighteen hundred and fifty -three. The follow- 
ing table will show this: 



January 1st, 1854 
January 1st, 1855 
January 1st, 1856 
January 1st, 1857 
January 1st, 1858 
January 1st, 1859 
January 1st, 1860 
January 1st, 1861 



24,524 

24,896 
25,485 
26,305 
27,028 
27,878 
28,761 
30,239 



The increase was enormous from eighteen hundred and thirty-six to 
eighteen hundred and forty-six, each quinquennial period presenting an 
increase of five and a half per cent; but since eighteen hundred and 
forty-six the progression has been greatly diminished. It appears: 



From 1846 to 1851 
From 1851 to 1856 
From 1856 to 1861. 



3.71 per cent. 
3 87 per cent. 
3.14 per cent. 



These results should not astonish. The increase in the population of 
asylums corresponds to' the relief which they bring to the lot of the 
insane — a new organization, in which much more attention is given to 
the conditions of material life of the patients than formerly. On the 
other hand, the foundation of new establishments; the confidence in- 
spired by officers and physicians; and, it must be allowed also, the 
greater facility of communication. The changes brought about within 
thirty years in our customs, in our needs, all favored this movement of 
entry. It was the necessary result, foreseen in advance, of a new order 
of things. JSTow the equilibrium tends to become reestablished, and we 
doubt not that from this time for some years a sensible diminution will 
be proved in the still continuous increase of w^hich statistics accuse us. 
Everything has contributed to increase these numbers; and it is from 
settled convictions that we assert that there has not actually been the 



* Annals of Public Hygiene and Legal Medicine, Second Series, vol. xi, p. 197. Motet. 



70 

enormous increase which is indicated. The investigations have been 
more carefully made during these last ten years than they had ever 
been. Those of whom information was sought understood the import- 
ance of such work, and the French Statistical Bureau has been able to 
collect materials much more complete than those heretofore placed at 
its disposal. This result, the extent of which will be better appreciated 
in the future, is due to the active and persevering energy with which 
M. Legoyt has inspired every department of his administration. 

If the population of the asylums increases, the proportion of the 
insane in relation to the population of France ought also to increase; 
but it is important constantly to bear in mind, in presence of these 
figures, the increased extent each year of public assistance; more 
patients relieved and treated; that is all which can be deduced from 
them. Thus it is estimated in 



Year. 


Population of France. 


Insane Under 
Treatment. 


Proportion to Population. 


1851 
1856 
1861 


35,783,170 
36,139,364 
36,717,254 

- 


21,353 

25,485 
30,239 


1 to 1,676 inhabitants. 
1 to 1,418 inhabitants. 
1 to 1,214 inhabitants. 



This is not the exact proportion of the insane to the total population 
of the Empire; we must add the insane remaining in families, of which 
the number was in eighteen hundred and fifty four nearly twenty-four 
thousand four hundred and thirty-three individuals; in eighteen hundred 
and fifty-six, thirty-four thousand and four; in eighteen hundred and 
sixty-one, fifty -three thousand one hundred and sixty — which makes for 
this last year, including the insane treated in asylums, about two insane 
to one thousand inhabitants. To what, then, is this increase due? To 
the idiots and cretins being included in the statistical tables, and it is 
impossible on seeing their number increase from twenty -five thousand 
two hundred and fifty-nine in eighteen hundred and fifty-six to forty- 
one thousand five hundred and twenty-five in eighteen hundred and 
sixty-one, not to conclude, as M. Legoyt has judiciously done, that there 
was a serious error, the more easily committed since the greater part of 
the idiots and cretins remain at home; since previous to eighteen hun- 
dred and sixty o le they were confounded with the general population, 
and sinCe, if in accordance with the more complete instructions given 
to the Census Marshals, they have been classed apart, it is not surprising 
that results so different in aj)pearance have been obtained. This reason 
(a more rigid, more exact appreciation of mental condition) should be the 
true one. 

It is scarcely probable that the number of idiots increased everywhere 
at once. But one thing is certain, that in eighteen hundred and fifty-six 
there were only two thousand eight hundred and forty idiots in the 
asylums, and in eighteen hundred and sixty-one three thousand seven 
hundred and forty-six of them were counted. The influence of Ferrus 
had made itself felt; he had, in a remarkable report, described the incon- 
venience which might arise by withdrawing imbeciles and idiots from 
the action of the law, and the administrative power had adopted his 
views. The number would have increased much more if they had not 



71 



made so great a restriction in the admission of idiots. It would doubtless 
be desirable that all who belong to indigent families should be effectually 
relieved. There is, in this way, a progress to be effected, and some 
efforts have already been made; but it is difficult to think of placing 
indefinitely in an asylum inoffensive beings who live a wholly vegeta- 
tive life. It is at the same time imposing too heavy a tax upon the 
department, and, on the. other hand, increasing a burden which is already 
too real in a large number of our asylums. Moreover, under the general 
name of idiots is included a class of beings who are not entirely useless. 
There are imbeciles, feeble minded, as they are called in some localities, 
who are good workers and who regularly accomplish a slightly compli- 
cated task. Until now they have been unnoticed in statistical state- 
ments; they appear there now, and augment by so much the total 
number. The situation is not then so deplorable as might have been 
supposed, and we believe that the deviation will be much less for several 
years from now. 

"What we have remarked concerning the influence of the reorganiza- 
tion of asylums upon the increasing number of insane under treatment 
is especially noticeable in the statements of the admissions. One is con- 
vinced, by consulting them, that the greatest increase corresponds to the 
period nearest to the promulgation of the law of eighteen hundred and 
thirty-eight. M. Legoyt divides the period from eighteen hundred and 
thirty-five to eighteen hundred and sixty into five sub-periods, and he 
finds that the proportional increase has been, annually: 



YEAES. 


Per ct. 


From 1840 to 1844 


7.94 


From 1845 to 1849 


3.38 


From 1850 to 1854 


3.83 


From 1855 to 1860 


2.00 







Here is also the exact number of admissions from 1854 to 1860: 



1855 
1856 
1857 




10,314 

10,086 
10,785 



Which gives, as the annual mean of admissions, about nine thousand 
three hundred and fifty -three insane, seven hundred and' twenty-seven 
idiots, and eleven cretins ; hence, of one hundred patients admitted, 
there were ninety-two insane, seven idiots, and one cretin. 

The admissions are voluntary, that is to say, requested by the families, 
or officially ordered by the authorities. The tables which we have here 
do not make a distinction which is, nevertheless, of some importance. 
Nearly two thirds of the admissions into the departmental asylums are 
made officially; in the departments for pensionnaires, in the private insti- 
tutions, including Charenton, there is nothing like it. This occurs, 
doubtless, from the negligence of the families of the indigent insane, 



72 

from the slighter disturbance of private interests which the presence of 
an insane person creates, and also from prejudices which have not yet 
entirely disappeared among the poorer classes, and which are no longer 
shared by the better educated classes. The voluntary entries were: 



In 1856 in the proportion of. 

In 1857 in the proportion of. 

In 1858 in the proportion of. 

In 1859 in the proportion of. 

In 1860 in the proportion of. 



30.20 per cent. 
31.19 per cent. 
32.02 per cent. 
30.61 per cent. 
32.02 per cent. 



The official entries were: 



In 1856 in the proportion of 
In 1857 in the proportion of. 
In 1858 in the proportion of. 
In 1859 in the proportion of. 
In 1860 in the proportion of. 



69.80 per cent. 

68.81 per cent. 
67.98 per cent. 
69.39 per cent. 
67.98 per cent. 



In wealthier families, where the physician is called, if not at the com- 
mencement of the insanity, at least as soon as it becomes serious, the 
situation is different. Judicious advice is given and often promptly fol- 
lowed. They do not wait for the interference of the authorities to effect 
an entry; they hope, on the contrary, that by combating the disease in 
season they will have better opportunities of eradicating it, and the 
official entry, which is so common to asylums, becomes almost the excep- 
tion in private establishments. This may be seen by the following fig- 
ures, which are a statement of the admissions into the hosjrital (maison 
de sante) directed by Dr. Mesnet and myself: 



1856 — 54 admissions, of which 
1857—68 admissions, of which 
1858 — 74 admissions, of which 
1859 — 74 admissions, of which 
1860 — 54 admissions, of which 
1861 — 59 admissions, of which 



9 were official 

8 were official 

9 were official 
7 were official 
4 were official 
4 were official 



16.65 per cent. 
11.76 per cent. 
12.15 per cent. 

9.45 per cent. 

7.40 per cent. 

7.14 per cent. 



No other conclusion of interest can be drawn from it; in the asylums 
the entries, which are, after all, a kind of public assistance, should be 
under the supervision of the administrative power, and the right of con- 
trol which it reserves is not excessive. It is known, moreover, that it 
never refuses to open the doors of its special establishments when a 
request really justifiable is made; the entry, which, for paupers, is always 
made by means of the authorities, takes the name of official entry for 
that reason; but, if we except insane vagabonds, incendiaries, and homi- 
cides, the Mayors and Prefects never make the decision before having 
been sought by the family. One need not, then, infer from these figures 
(which might at first surprise) too frequent or too great an intermeddling 



73 

of the administration in the sequestration of the insane. For the large 
towns, which, like Paris, have private hospitals, the official entries have 
taken place only in desperate cases; and when* an insane person has 
been arrested upon the highway his family is immediately notified, if 
possible, and invited to designate the establishment in which they wish 
the patient to be entered. At Paris, it is the Prefect of Police who 
makes the arrest. He uses the right which the law gives him to protect 
public order and personal safety, and one cannot complain when authority 
takes the place of an absent or negligent family. We insist upon this 
point, for this right of authority is now contested with more passion 
than propriety; if all the difficulties, all the embarrassments which are 
constantly created by the insane in society were well understood; if the 
consequences of their acts were examined without prejudice, and inter- 
vention always useful, never arbitrary, would perhaps be less promptly 
censured. And allow us to say, there are insane and idiots for whom 
sequestration in an asylum would be a blessing; they would escape ill 
treatment, detestable calculations dictated by base cupidity; recent facts 
which have been developed by tribunals have shown but too well how 
far cruelty and ill usage of poor, defenceless beings may be carried. 
We believe, therefore, that it is well to leave to the Mayors and Pre- 
fects the liberty of the initiative, and that to withdraw it would be to 
promote the development of abuses already but too common. 

The number of women in the asylums is always a little larger than 
of the men, and nevertheless the admissions are in an inverse propor- 
tion. The reason of this fact is that the discharges and deaths, and the 
mean length of residence, differ much for the two sexes. The mortality 
and the discharges attain a higher figure among males than females. We 
shall refer again to this subject. The following are the figures corres- 
ponding to the period eighteen hundred and fifty-four to eighteen hun- 
dred and sixty, for the patients present at the end of each year: 



YEAK. 




Females. 



1854 
1855 

1856 
1857 
1858 
1859 
1860 



12,036 
12,221 
12,632 
12,930 
13,392 
13,876 
14,582 



12,860 
13,264 
13,673 
14,098 
14,486 
14,885 
15,657 



This difference had been already noted from eighteen hundred and 
forty-two to eighteen hundred and fifty-four. The proportion was, per 
hundred, forty-seven and seventy-seven one hundredths males, and fifty- 
two and twenty-three one hundredths females. From eighteen hundred 
and fifty -four to eighteen hundred and sixty it is nearly the same, for we 
find among one hundred patients forty-eight and ten one hundredths 
males, and fifty-one and ninety one hundredths females. This is not the 
case among idiots and cretins. Subtracting these from the total num- 
ber of insane under treatment, we find among one hundred idiots and 



10 



74 

cretins fifty-one and twenty-two one hundredths males, and forty-eight 
and seventy-eight one hundredths females. 

One of the most interesting subjects of study is that of the curability 
or incurability of the insane under treatment. But who does not com- 
prehend at the same time how researches of this nature must lack 
correctness? Let us, therefore, attach but an indifferent importance to 
the figures furnished us by statistics. They are approximate results, 
which could only acquire a real value in case it were possible to estimate 
singly the statistics of each asylum after having deducted from its lists 
the epileptic, the paralytic imbeciles (les dements paralytiques), the idiots 
and the cretins, for whom incurability is no longer a presumption, but a 
certainty. We shall not insist upon this point; when the discharges by 
recovery are presented to us we shall find more exact means of estima- 
tion, and such as will better merit our consideration. 

At what age is insanity most common? Statistics previous to eighteen 
hundred and fifty-four agree with those which have just been published; 
it is from thirty -five to forty years that we find the most insane of both 
sexes. It is likewise the period of life at which males and females 
expend the most physical and intellectual activity. It is the age of 
complete development; it is also that at which trials are most numerous. 
Thus of seven thousand two hundred and ninety-two insane persons 
admitted (mean year) for the first time, from eighteen hundred and fifty- 
six to eighteen hundred and sixty, we find: 



YEAKS. 



Males. 



Females. 



Total. 



From 20 to 30 years 
From 30 to 40 years 
From 40 to 50 years 



762 
1,107 

857 



688 
888 
676 



1,450 
1,995 
1,533 



Beyond this period of life the proportion of females increases; at a 
single period there is almost an equality; it is from fifty to fifty-five 
years— we find four hundred and ninety-five males and four hundred 
and fifty-eight females. 



YEAES. 



Males. 



Eemales. 



Total. 



From 60 to 70 years 
Above 70 years...;... 



243 
101 



324 

182 



567 
283 



Among idiots and cretins it is from twenty to thirty years that the 
greatest number of admissions takes place. That is readily understood; 
it is the time at which these unfortunates become most troublesome to 
the family and to society, especially those whose physical development 
is not too incomplete, and who manifest all sorts of impulses — blind 
passions which it is often difficult to control. What is the result in the 
families of these poor creatures for whom constant watchfulness is neces- 
sary, and who become a deeper and deeper source of anxiety? They 



75 

embarrass labor and they oppress by too heavy a tax an account already 
limited; it becomes necessary to part with them, and to ask their admis- 
sion into the asylum. Above fifty years the number of admissions is 
reduced a little; it might descend to zero without our being astonished, 
for idiots rarely live to that age; it seems probable to us that they must 
have inserted in the table individuals who are only imbeciles; for the 
latter, indeed, the duration of life is more extended than for idiots. 

The civil condition of the insane admitted for the first time, from 
eighteen hundred and fifty-six to eighteen hundred and sixty, has been 
stated most carefully, and offers us the following results : 



Males. 



Females . Total 



Single 

Married 

Widowers and widows... 
Civil condition unknown 

Totals 



9,545 

7,731 

1,327 

545 



19,148 



7,624 
6,671 

2,718 
298 



17,311 



17,160 

14,402 

4,045 

843 



36,459 



The number of unmarried insane is of itself as considerable as that of 
the married and widowed insane. All statistics agree upon this point. 
Is it because celibacy predisposes one to insanity? This problem has 
long been agitated, and the solutions are various. An unmarried person 
retains a greater freedom to temptation, and he yields more readily to 
those allurements which family relations diminish, if they do not entirely 
efface; life is less regular, less calm; in trial it is less encouraged, less 
supported, and having, generally, no one near to care for him if attacked 
by insanity, the doors of the asylum or of the hospital will open far 
more readily to him than to any other. The causes of the numerical 
superiority of unmarried persons in the admission are therefore complex. 
They have not escaped the sagacity of M. Legoyt, who has judiciously 
described them. As to widowhood* it seems to exercise a more unfavor- 
able influence upon females than upon males; but to make a correct 
estimate it is necessary to find out whether women do not oftener remain 
in the condition of widowhood than men, and whether, also, the moral 
causes do not play the most important part in these new conditions. 

As for the preceding statistics, the examination of the professions fur- 
nishes a sad lesson. It is from among the laborers of thought that 
insanity receives most victims.") - For the period included between eigh- 
teen hundred and fifty-four and eighteen hundred and sixty these state- 
ments give the enormous number of forty-six hundred and twenty per- 
sons engaged in the liberal professions. Compared with the total num- 
ber of admissions this result presents a proportion of ten per cent. See 
the following table: 



* I have no English word more nearly corresponding to 
which I use for both sexes. 



veuvage " than widowhood, 



t Our investigations lead us to helieve the reverse of this to be true in all other countries 
than France. 



76 



YEAES. 


Number en- 
gaged in 
the Liberal 
Professions 


1854 to 1855 


1,839 


1856 


511 


1857 


544 


1858 :. 


497 


1859 


658 


1860 


571 








Total 


4,620 







During the same time there were sixty-eight thousand nine hundred 
and ninety-two admissions. If in round numbers we deduct twenty 
thousand idiots and cretins, there remain forty-eight thousand nine hun- 
dred and ninety-two admissions, of which four thousand six hundred 
and twenty represent individuals having received a liberal education. 
Clergymen and members of religious orders amount to twelve hundred 
and forty-eight; physicians, apothecaries, and midwives, to six hundred 
and thirty-three; professors, learned men, and men of letters, one thou- 
sand and ninety -three; artists, sculptors, painters, musicians, eight hun- 
dred and sixty. The rest of the catalogue are notaries, advocates, 
bailiffs, and public officers or employes. The other professions are far 
from furnishing so large a quota. This is, as M. Brierre de Boismont 
has remarked, another argument in favor of the opinion of those who 
think that the progress of civilization affects the development of insanity. 
It is just to add, nevertheless, that it is among this class of persons 
that the excitements of life are most incessant, that ambition is most 
feverish, and that the sensibility to display constantly kept in exercise 
is liable to the greatest extremes. Military and seafaring men are not 
spared; then come, finally, stockholders and proprietors, the manual or 
industrial professions, domestics or hired laborers, and farmers. The 
inhabitants of towns constitute more than one half the annual admis- 
sions, and yet the proportion of the people of the rural districts to those 
of the towns is as three to one. There are many causes which effect 
this result. The insane person is more easily guarded in the rural 
districts than in towns; his presence in the family does not so necessa- 
rily become the occasion of difficulties and embarrassments of all kinds; 
there is more room for him, and fewer causes of annoyance; if he is 
sometimes noisy, the neighbors are not disturbed by his cries, so he may 
remain at home a long time if he is inoffensive. The citizen, even if he 
were just as docile and easily governed, becomes, from the fact of his 
insanity, 'a source of consant anxiety. The asylum or private establish- 
ment which will open its doors to him will give him a material benefit 
which he cannot obtain at home, where, for various reasons, he would be 
habitually confined to his chamber. On the other hand, in a family 
whose means are quite limited the incapacity of one of its members 
becomes a source of expense which the entry into an asylum at the 
present very moderate charge immediately reduces. These are constant 
facts, and if we add thereto the excitements constantly renewed, the 



77 

need of luxury and more active enjoyment, the more frequent deception, 
the watching, the excess, etc., we shall understand the enormous dispro- 
portion which is presented to us in the following figures: 



1856 to 1860. 



Inhabitants of towns 

Inhabitants of the country 
Residence unknown 

Totals 




9t- 



3 jo 

: Pj 



950 
1,481 



2,529 



M. Brierre de Boismont ascertained the same facts in preceding statis- 
tics, arid the reasons by which he supports them remain true in our day. 
There is a perfect accordance, just as in the researches made to ascer- 
tain which are the departments which furnish the mos't insane. They 
are still the Seine, Seine Inferieure, Seine and Marne, the Rhone, Seine 
et Oise, the Eure, the Loiret, the Bouches du Rhone, £he Cote d'Or, and 
the Yonne. 

To conclude that which relates to admissions, we still find, as in the 
past, that the Summer months are the months of the most numerous 
admissions — that the Winter months are less fruitful. 

The study of causes presents difficulties of more than one kind. We 
must not rely upon the very rigid estimates of statistics essentially offi- 
cial. There is not a physician having lived among the insane who does 
not remember the extreme embarrassment in which he has often found 
himself when he has tried to analyze the diverse influences which have 
produced the development of insanity. It is very rare to find only one 
of the number to which we can with certainty ascribe the actual de- 
rangement. Be that as it may, there is a portion of truth in the tables 
which M. Legoyt has prepared; and as it was not possible for him to 
obtain more accurate statements, we will accept them. Among these 
causes hereditary takes the lead. Modern works, those of Baillarger in 
particular, have represented its full importance. Of twenty-eight thou- 
sand six hundred and twenty-one insane of both sexes, of whom the 
friends have given the necessary information, there are reckoned four 
thousand and fifty-six whose father or mother had been attacked by 
insanity; and pursuing the analysis still further, of the insane admitted 
in eighteen hundred and fifty-nine and eighteen hundred and sixty it has 
been found that hereditary transmission is in some degree obedient to 
the law of propagation from sex to sex. The insane mother transmits 
the insanity to her daughters, the father to his sons. We reproduce the 
following table, which relates to fifteen thousand two hundred and thir- 
teen insane: 



78 



CAUSES. 


Males. 


Females. 


Total. 


Issue of an insane father 


412 
356 

83 
2,367 

4,862 


294 

403 

110 

2,132 

4,194 


706 


Issue of an insane mother 


759 


Issue of an insane father and mother* 


199 


Issue of a father and mother not insane.,. 

Unknown 


4,499 
9,056 






Totals* 


8,080 


7,133 


15,213 







This gives, out of one thousand insane males, two hundred and sixty- 
four bearing the hereditary taint, one hundred and twenty-eight from 
the father's side, one hundred and ten from the mother's, twenty-six 
from both sides at the same time; of one thousand insane females, one 
hundred from the father's side, one hundred and thirty from the mother's, 
and thirty-six from both sides. 

What is the share of the causes called physical and of the moral causes 
in the development of insanity? For a great number, as we have already 
said, it is very difficult to succeed in separating them fully. Sometimes 
they succeed each other as consequences the one of the other; some- 
times they are so closely linked that any distinction becomes impossible; 
but what is beyond doubt is that drunkenness presents itself in a great 
number of cases. M. Brierre de Boismont tried vainly to diminish its 
influence when he wrote: "The man who drinks to divert his thoughts 
from disappointment, and becomes insane, has at first acted under the 
influence of a moral cause." This reasoning, which justly exhibits the 
complications which -may exist among physical and moral causes, is only 
applicable to a small minority. Now that attention is aroused in this 
direction, it is beyond doubt that insanity receives the greater rfumber of 
its victims from among persons addicted to the use of alcoholic drinks. 
The nature of intoxication may be curious to determine, for if it is true 
that, under one form or another, it is always the alcohol absorbed which 
acts upon the cerebral functions, it is no less true that certain prepara- 
tions into which it enters in a highly concentrated degree give a more 
rapid progress to the disease, and a peculiarly serious character. A 
remarkable fact, and one which our personal researches have presented 
in all statistical tables, is that it is not in wine countries that delirium 
tremens is most frequent. It is in the large towns, in cities where indus- 
try is most developed and most active, where there is the greatest 
agglomeration of population, that delirium tremens is most common. It 
is, moreover, more frequently found at the north than at the south; and 
we do not consider ourselves guilty of exaggeration in attributing to the 
improvements made in the distillation of beet root, potatoes, and grains 
a large share of the increase in the number of the insane. One is justi- 
fiably startled at finding that more than one fourth of the persons whose 
insanity is attributed to physical causes suffer the penalty of alcoholic 
excess. Of eight thousand seven hundred and ninety-seven persons, 
three thousand and fourteen were drunkards. Even women pay their 



* This is a correct copy of the figures presented in the original, but there is evidently 
an error, which I conclude is in either the males or females of the third item — eighty-three 
for eighty-nine, or one hundred and ten for one hundred and sixteen. 






79 

tribute to this degrading cause. They are, however, in much smaller 
number — four hundred and forty-one out of seven thousand and sixty- 
nine. After this comes, in order of frequency, advanced age (l'age 
avance), diseases of various organs, epilepsy, various diseases of the 
nervous system, Onanism and venereal excesses, destitution and misery, 
accidents and wounds. Among females, disorders of the genital organs, 
appearing either at the time when the uterine functions are most active 
or when they cease, are one of the most frequent physical causes of 
insanity. The proportion is one thousand five hundred and ninety-two 
out of seven thousand and sixty -nine. 

Among moral causes, domestic disappointment plays the most impor- 
tant part. Of four thousand nine hundred and nineteen men, nine hun- 
dred and eighty became insane from this cause; of five thousand four 
hundred and thirty-eight women, one thousand five hundred and 
sixty-nine under the same influence. This is a little more than one 
fourth, especially if we add thereto the disappointments resulting from 
loss of friends, and which may, in a great majority of cases, appear 
among domestic disappointments (chagrins.) Afterwards come disap- 
pointments resulting from Iqss of fortune (851), from disappointed ambi- 
tion (520), excitement of religious feelings (1095), excess of intellectual 
labor (358), love (767), jealousy (456), pride (368), anger (123), remorse 
(102), isolation and solitude (115), simple imprisonment (113), imprison- 
ment in cell (26), nostalgia (78), from a total of ten thousand three hun- 
dred and fifty-seven of both sexes. 

Under this title ("Aggravating Circumstances ") is found one of the 
most instructive paragraphs of all M. Legoyt's publication. General 
paralysis is there considered as the complication of insanity, and its rela- 
tion to the total population of the asylums is precisely stated. A com- 
parison between preceding and present statistics presents an increase 
of one half; and for ourselves, who live in special circle, in a private 
hospital where only the insane of the wealthier classes are received, we 
do not find this number so great. For ten years we have seen general 
paralysis becoming more frequent; it appears sooner in the life of man, 
and if one considers that this terrible malady attacks without mercy the 
most gifted, one cannot help feeling profound pity for the poor creatures 
who, in the midst of their insanity, retain the most delusive ambition — 
who, with simple credulity, delight in the most deceptive chimeras. 
The dementia {demence\ which attacks them almost unawares, the dimi- 
nution of their strengtn together with that of their intellect, the progres- 
sive deterioration, which may be traced, step by step, is one of the saddest 
and most heart-rending pictures which can be imagined. Nothing stays 
its victorious march; with scarcely, from time to time, a few periods of 
abatement, abruptly broken by the retura of cerebral congestion, with 
epileptic (epileptiformes) convulsions, and death, after eighteen years or 
two months of a purely vegetative existence, coming to end the sad trial 
— this is what we have daily before our eyes. Paralytic imbeciles (les 
dements paralytiques) now present, in the admissions, a number relatively 
large. From eighteen hundred and forty -two to eighteen hundred and 
fifty-three the proportion was: for males, six per cent; for females, three 
per cent. From eighteen hundred and fifty-six to eighteen hundred and 
sixty the number increases to twelve per cent for males, and remains 
three per cent for females. " Ce'st que la paralysie generate semble recon-. 
naitre pour cause tout ce que sur excite Vappareil encephalo-rachidieu;" in its 
etiology is found excess of all kinds, as well of pleasure as of labor, and 
the ambitious delirium which is one of its commonest characteristics is 



80 

very often only the incessant preoccupation of those whom it attacks in 
the midst of their need of relaxation, of their insatiable desires. It is 
only too certain that, in these later years, general paralysis has had many 
more victims; what we have ourselves observed is confirmed by general 
statistics. Among epileptics the proportion seems to have diminished; 
we do not well explain to ourselves from what influences; we state this 
result. From eighteen hundred and forty-two to eighteen hundred and 
fifty -three it was, for males, eight and eight tenths per cent; among 
females, six and four tenths. From eighteen hundred and fifty-six to 
eighteen hundred and sixty it is only four and thirty-one hundredths 
among males, and three and seventeen one hundredths among females. 
Something here has escaped us, and we are inclined to think that in pre- 
ceding statistics the number of epileptics under treatment were given; 
in the present, that of the epileptics admitted during the period, which 
is very different. In both cases the males are represented by a higher 
figure than the females. 

Hitherto we have considered only a single side of the question. It 
remains for us to see what becomes of the insane admitted and treated 
in the asylums — that is to say, to study the discharges before or after 
recovery, and the deaths. 

The proportional number of the insane discharged before or after 
recovery was fourteen and forty-six one hundredths per cent from 
eighteen hundred and fifty-four to eighteen hundred and sixty. This 
number is a little less than that of the period eighteen hundred and 
forty -two to eighteen hundred and fifty -three, during which it was six- 
teen and thirty-six one hundredths per cent. But that which was 
proved at that epoch is also found to-day — more males are discharged 
than females. Insanity of alcoholic origin, which is generally cured 
quickly, being more common among males than among females, will in 
part explain this difference, if we do not also find, to the disadvantage 
of females, all chronic diseases of the uterus, difficulties succeeding 
delivery, irregular menstruation, etc. Depression has not so deep or so 
lasting an influence among males. These are all so many favorable causes 
which lead to a more certain and speedy recovery. Be this as it may, 
the proportion of discharges after recovery seems to have diminished — 
that of discharges before recovery to have increased a little. We do 
not think, for our part, that the difference can be very great. Many 
patients leave our establishments, public or private, reclaimed by their 
friends before their recovery can be completed. The heads of the office 
report them as improved, but not cured. It is necessary, in order that 
the estimate may be correct, to know what has become of these con- 
valescents, who for the most part, attain perfect health. These docu- 
ments are wanting; all correction is impossible, and the numbers have 
only an entirely relative value. Thus the mean of discharges after 
recovery, from eighteen hundred and fifty-four to eighteen hundred and 
sixty, was only seven and seventy-seven one hundredths per cent of 
patients treated; of discharges before recovery, six and sixty-eight one 
hundredths per cent. Brierre de Boismont had good reason to say, in 
eighteen hundred and fifty -nine, that it should not be estimated thus. 
Too many elements are found in these statistics, and cannot be officially 
separated to make the estimate correct. Who does not see at once that 
the general paralytics included in the total number of insane (for exam- 
ple) fatally condemned to incurability, the epileptics, nearly all in the 
same condition, make of themselves alone the proportion of the chronic 
insane considerable; the proportion per cent of cures is reduced at once 



81 

before them, and to attain a really scientific, really correct data, Ave 
should take the acute forms presumed to be curable, and then see the 
results obtained. If we should adopt this course, which after all will not 
lead to very great complications in the formation of tables, we shall not 
be discouraged by the disheartening figure of seven or eight per cent of 
cures. This is the weapon of which the opponents of the law of 
eighteen hundred and thirty-eight most readily make use. 

Indeed, to one who has not the power to explain it there is something 
very sad in these official statements. We are not reduced to a situation 
as discouraging as might at first be believed; and M. Legoyt himself 
comes to our aid by saying that among the insane treated who are most 
certainly cured are military and seafaring men. Why? Because they 
are men in the strength of youth, who are* generally attacked by acute, 
curable forms of mental alienation; because they are submitted to a care- 
ful examination at the commencement, and because the disease is treated 
almost as soon as it appears. General paralysis, which we justly accuse 
of increasing the number of our failures, does not yet appear among 
them. It is from thirty-five to forty -five years that it commits the 
greatest ravages. Let one deduct from the total number of insane 
treated the epileptics, the j)aralytics, the idiots, and the cretins; let him 
retain the acute forms, in indicating each year the probable prognostics 
of those remaining under treatment, and he will see that the recoveries 
are not so rare as he thinks. As to the discharges before recovery, we 
do not attach any more importance to them than they deserve. What 
are they generally? Fruitless trials which, after short duration, result 
in return to the asylum. They are escapes followed sooner or later by 
reentry; they are also transfers from one establishment to another, of 
which care had been taken to keep an account. A more correct data, 
and conformable, moreover, to the observations collected by the chefs de 
service, is that of length of treatment among the insane cured. Of thir- 
teen thousand six hundred and eighty-seven insane discharged after 
recovery, sixteen hundred and sixty-three were discharged after a resi- 
dence in the public or private establishments of one month or less. The 
greater number, eighteen hundred and eighty-seven, were discharged 
after five or six months of treatment; fifteen hundred and nineteen after 
seven or eight months; seventeen hundred and forty-eight in the second 
month. It is, then, in the first months which follow the attack of insan- 
ity that the cures are most numerous; let us add, also, that they are 
most certain; yet it might have been important to describe the forms 
which are most quickly relieved. All insanity of alcoholic origin, 
especially if the habit of drinking is not inveterate (if there has not 
been a previous attack), is decided in a period of from one month to six 
weeks. An attack of mania or of true melancholy (irielancolie tranche) 
runs its course in five or six months; a few, nevertheless, have lasted a 
shorter time. Here the influence of cause makes itself felt, and the 
influence of constitution; and if one could determine the date of the 
appearance of the derangement, in view of these speedy cures, he would 
see that the insane who are soonest improved are those who have been 
most promptly treated. Moreover, we join without reserve in the idea 
which M. Legoyt has thus expressed: "It is evident that it is the 
interest of families, and consequently of society, that the insane should 
be placed under treatment as promptly as possible." As to the season 
of the year at which the recoveries take place, ttie following has been 
observed of one thousand recoveries; 
H 



82 



Months. 



December, January, February.. 

March, April, May 

June, July, August 

September, October, November. 

Totals 




Females. 



195 

248 
283 
274 



1,000 



We deem it proper, also, to show the effects of the seasons on mor- 
tality, and for this purpose insert the following from the Thirteenth 
Scotch Report: 

" Cold increases the mortality among all classes of the population, and 
accordingly the deaths in asylums are most numerous in the colder 
months. But it is worthy of notice that while the mortality of both 
sexes is higher in Winter than in Summer, there is a difference in the 
tendency to death in the two sexes in the two seasons. 

" Of every one hundred deaths which took place in asylums in the six 
years from eighteen hundred and sixty-five to eighteen hundred and 
seventy, fifty-three and fifty-four one hundredths took place in Winter, 
and forty-six and forty-five one hundredths in Summer. The number of 
deaths of both sexes is greatest in Winter, but the tendency to death is 
in Summer greater among females than males. This is shown by the 
following table: 

Table, 

Showing the Mortality in Summer and Winter in the Asylums of Scotland 

for six years, 1865-1870. 



Summer. 
]^ay to October. 


"Winter. 
November to April. 


Male Mortality. 


Female Mortalitj 7 -. 


Male Mortality. 


Female Mortality. 


620 


690 


789 


721 



As to age, it is from twenty -five to thirty -five years that the greatest 
success is obtained; beyond this age the number of recoveries gradually 
decreases, as the activity of the mental faculties also diminishes. The 
following are approximately the causes among about one half of the 
patients recovered of whom, alone, any positive information could be 
obtained. Drunkenness, seventeen hundred and thirty-eight; domestic 
disappointments, eleven hundred and seventy-one; various diseases, 
seven hundred and sixty-one; diseases peculiar to females, seven hun- 
dred and twenty-three; religious excitement, four hundred and sixty. 
Hereditary tendency has been noted among fifteen hundred and twenty- 
two cured — about fifteen per cent. 

The mortality appears to have increased slightly in the asylums in 






83 

the period inel tided between eighteen hundred and fifty-four and eigh- 
teen hundred and sixty. In the preceding years it was thirteen and 
seventy-five one hundredths per cent; in these last seven years it has 
been fourteen and three one hundredths per cent. It is unnecessary to 
seek for reason other than the cholera epidemic of eighteen hundred 
and fifty-four. It decreased in eighteen hundred and fifty-nine to thir- 
teen and eighteen one hundredths per cent, and in eighteen hundred and 
sixty to twelve and fifty-seven one hundredths. Of an equal number, 
one hundred and thirty-one males die to one hundred females. More 
than twelve per cent of the mortality among the insane took place 
within the first month of residence in the asylum, and this number, rela- 
tively very large, has given rise to explanations which are not in accord- 
ance with facts. It is said that "the cause of these speedy deaths must 
be the arrest, the violent agitation, the deep disappointment which 
])atients must experience on being abruptly sejjarated from their fami- 
lies — confined, without knowing the reason, in this violent way." This 
is not the truth. The insane who die so quickly bring to the asylum 
the diseases under which they sink. "We have means to prove that there 
is only a very small number who have a semi-consciousness of change of 
place. 

Not to extend the limits of this resume, we shall present the figures 
for three years only. TTe have gathered them ourselves, we know all 
the particulars of the disease, and we can prove that moral disturbances 
have counted for nothing in the rapidity of the fatal termination. What 
we have noticed many officers have also observed, and Brierre de Bois- 
mont has devoted himself to refute an opinion which has not failed to 
produce a sad impression. Figures seem to err. It is evident that more 
than one fourth of the total number of deaths are to be attributed to 
the first three months. But why? It is because frequently there are 
brought to the asylum poor patients attacked sometimes with cerebral 
tumors; sometimes with organic diseases of the respiratory, digestive, or 
circulatory organs; sometimes with pneumonia and fevers; sometimes 
with alcoholic intoxication with complication. They have been cared 
for as far as could be at home. They have only been sent away when 
frightful hallucination, continued shrieks, and ungovernable impulses 
have made it dangerous or impossible. A few days more and they would 
have died at home. They are brought; the journey is very fatiguing to 
them; they arrive exhausted; they sink in the midst of a delirium 
which has not even allowed them time to perceive that they have been 
confided to the hands of strangers. The asylum, then, should not be 
accused; it is the first disease, of which insanity is then only an acci- 
dental manifestation. 

One may better judge from the following table, which sums up our 
professional observations. 

In eighteen hundred and sixty-four, of fifteen deaths (eleven males, 
four females), six died in less than a year after their admission: 



84 



AGE. 


Nature of the Disease. 


Length of Residence. 


1. 


70 years 

33 years 


Delirium tremens, third attack; epilep- 


Left May 7th, 1863; relapse; 
reentered January 9th, 1864; 
died the 13th; four days. 

Three weeks. 

Eight days. 

Two days. 
Twenty-nine days. 
Fifteen days. 


2, 
3. 


Acute delirium, agitation, and constant 

Consumptive; cavernes aux deux som- 
mets; delire de persecutions 


4. 


Sordid avarice; privations of all kinds; 
allowing himself to starve in a garret. 
Interference of the Commissioner of 
Police. Inanition 


5. 


Typhoid fever, with hallucination and 
delire de persecutions; pneumonie 


6. 


Young woman married fifteen days pre- 
vious. Acute delirium; proved her- 







In eighteen hundred and sixty -five, of eleven deaths (nine males, two 
females), five died in less than six weeks after admission: 



AGE. 



Nature of the Disease. 



Length of Ees. 



1. 45 years 

2. 28 years 

3. 34 years 

4. 36 years 

5. 54 years 



Complete dementia (demence) with general paralysis; 

cerebral congestion; epileptic convulsions 

General paralysis a marche galopante; meningo enc6- 

phalite suraigue\... 

Meningo encephalite; maniacal delirium; official entry: 

nervous exhaustion produced by constant agitation.... 
Dementia, with general paralysis progressing rapidly; 

appearance of disease six months oefore; venereal 

excess; increasing debility (afifaiblissement) 

Consumptive; hallucination and delire de persecutions; 

agitation; death rather sudden 



One month. 
Six weeks. 
Eight days. 

Fourteen days. 
One month. 



In eighteen hundred and sixty-six the mortality reached a very high 
figure. From January first to September first we had twelve deaths — 
ten males, two females. Five males and one female died in the first 
month. We have rarely had a year more unfortunate in this respect. 
It will be seen in consequence of some sad circumstances, all accidental, 
moreover, that the length of residence has been so short. 



85 



AGE. 



Xature of the Disease. 



Length. Eesidence. 



1. 87 years 

2. 44 years 

3. 28 years 

4. 45 years 

5. 26 years 
fl. 39 years 



Appearance ten days previous; carried to the City 
Hospital, where his stay was impossible from his 
excitement and shrieks; acute delirium; pulse fili- 
forme 

General paralysis; complete dementia; convulsed 
condition . 

Young priest; sick for a month at the seminary; ex- 
citement and shrieks which terrified his colleagues 
and prevented their keeping him longer; six hours 
travel by rail; extreme exhaustion; pulse at one 
hundred and twelve; typhoid condition , 

General paralysis, dating three years back; cared for 
until now at home, but for some time creating all 
sorts of difficulties; intestinal obstructions; hal- 
lonnement enorme du ventre; asphyxie par com- 
pression 

Alcoholic excess having caused two previous attacks 
of delirium tremens; sick for fifteen days in a hotel, 
where he continued to drink; frightful hallucina- 
tion, shrieks, and violence; on entering, coldness 
of the extremities; pas de pouls 

"Woman . Dread ; sleeplessness ; delire lypemaniaque ; 
refused food; then acute delirium; maniacal ex- 
citement 



Twenty-four hours 
Six weeks. 



Three days. 



A half hour. 



Fifteen hours. 



Fifteen days. 



It may be thought that we have dwelt too long upon this point; but 
it seemed to us important to present these facts with some details; it is 
not possible to imagine them when one has only figures before his eyes ; 
but to every impartial mind it will be very apparent that the mental 
condition of those persons who died so quickly after their admission 
scarcely allowed them to appreciate the new situation provided for them 
by entry into the asylum. Not the arrest, then; not excited feelings — 
nothing but serious physical conditions, which of themselves were suf- 
ficient to produce death. Thus that sort of accusation which charges 
the asylum with a mortality whose very natural explanation need not 
be so far-fetched, falls of itself. 

There still remain a few subjects of comment. M. Legoyt completed 
his work by researches which, properly speaking, only the administration 
promotes. We do not stop there; we think we have said enough to set 
forth the qualities which characterize his work, at the same time con- 
scientious, impartial, and moderate in its estimates. If we do not always 
agree with him, it is because we look from a different point of view, 
placed as we are in conditions of special observation which allow us to 
go to the root of things. But we are pleased to acknowledge that it 
was impossible to have done better; and such as it is, the statistics from 
eighteen hundred and fifty-four to eighteen hundred and sixty constitute 
one of the most interesting documents of the, annals of mental alienation. 

Does this important work which we wish to show accuse us of a situ- 
ation as fearful as has been represented? We do not think so. It is 
impossible to deny an increase in the number of admissions; but it is 
just also to acknowledge that if the special causes which we have enu- 
merated have favored this increase, there is now a tendency towards an 
equilibrium, which we hope soon to see definitely established. Our 
regretted colleague, Parchappe, has noticed, with all the authority of a 
long experience, a few of these questions, in a discourse delivered last 



86 

year before the Medical Psychological Society at Paris.* We will not 
attempt, after him, to rehabilitate our asylums; whoever desires to be 
enlightened will ascertain very quickly the general movement, which, 
on all sides, tends towards progress, towards perfection, and, conse- 
quently, towards the amelioration of the lot of the insane. The statistics 
themselves prove to what extent everything is regularly conducted, 
seriously observed. The documents of which it is constituted were not 
obtained by an idle or ill-directed administration. There is in the supe- 
rior as in the inferior ranks of administrative hierarchy a unity of aims 
and tendencies which should suffice to reassure those who are disturbed 
because they do not well understand the subjects upon which they com- 
ment; for ourselves, who are witness of these efforts, who heartily unite 
in them, we cannot, without regret, see our intentions undervalued; we 
regret that we are judged with a frivolity which we should not have 
suspected among men whose habits of serious investigation should have 
given them an immunity from such deviations. We think that, in view 
of this formidable scourge, insanity, it were more generous to assist us, 
to sustain us in our sad task, than to create obstacles and to discourage 
us sometimes by unjust suspicions. Happily, duty accomplished brings 
its recompense with it; and if, in later times, we have been the object of 
attacks little deserved, this justice will at least be done us, that we have 
never refused to reply, not upon the ground of delusive theories, but 
upon that of facts. It has seemed exj^edient for our cause to review the 
work of a man as enlightened as capable, placed by his official situation 
in that quiet region penetrated neither by the spirit of party nor adven- 
turous ideas. We have made numerous drafts upon M. Legoyt, and • 
when, in some matters of detail, we disagree with him, it is because we 
have had in our hands documents which he always lacked. The statistics 
which he has published, more complete than those which preceded, are, 
in our idea, a work of rare value. They are one of the best arguments 
which can be presented to those who try to believe that we allow our- 
selves to be soothed by that easy quiet which accepts the past for fear 
of disturbing the future. 



CHAPTEE VIII. 
INSANITY AMONG THE ANCIENTS. 

COMPARATIVE VIEW OF THE CONDITION AND TREATMENT OE THE INSANE AT DIFFERENT 
PERIODS AND IN DIFFERENT COUNTRIES. 

In the time of the Ancients— In the Middle Ages— In the Eighteenth and Nineteenth 
Centuries — In England — In France — In Home — In the Germanic Confederation — 
Observations upon Foregoing Subjects— Cruel Treatment the Kesult of Ignorance — 
New York Poor Houses — Amelioration in the Treatment of the Insane as compared 
with Former Periods — Proof of the Advantage of Moral Treatment. 

The ancients regarded insanity as the result of some supernatural 
power; a visitation from some God, at whose shrine the person affected 
had refused to worship, or as a punishment for irreverance or crime; 
but the psychologists of modern times have endeavored to explain its 
mysterious effects on scientific principles. Some contend that the mind 

* Annals Me'dico-Psychologiques, 1865, p. 66. 



87 

alone is diseased; others that it is a disease of both body and mind; 
while the great majority regard it as " a disease of the brain affecting 
the mind;" and while the latter theory accords with our views, and is 
most readily understood, we propose to enter into no argument with 
those who have advanced and still maintain a different view, nor is it a 
part of the purpose of this report to enter into any metaphysical discus- 
sion on the various theories that have been advanced in this or any 
former period of time. 

That it is a disease in some shape, all will admit. That it is extremely 
curable when properly treated in its earliest stage, none will deny. That 
it is equally intractable and unmanageable after it has fixed itself upon 
its hapless victim, is a fact that those best acquainted with its subtle 
nature most deplore. It seems to be an inevitable if not a natural 
attendant upon the human race. It has been present among men from 
the beginning, or from the earliest records to the present day. 

The feigned madness of Ulysses,* immediately prior to the Trojan 
war, is perhaps the earliest reference in antiquity to the existence of 
mental disease — otherwise the madness of Saul claims priority. Ajax 
was seized with madness after the arms of Achilles had been awarded 
to his rival Ulysses. Orestes is also described as a madman by his sister 
Electra. 

The " heaven inspired Cassandra" was regarded by the Trojans as 
insane. Plato alludes to the connection of divination and insanity, the 
prophetess at Delphi and the priestess at Dodona both being considered 
as insane. The Sybil and others being classed in the same category, 
they were said to possess the mad art. 

Several other allusions are made to madness by Plato and other writ- 
ers of antiquity. Euripides makes many allusions to madness, and the 
power of Bacchus to produce it. Lycurgus, King of the Edones in 
Thrace, refused to worship Bacchus, in consequence of which the God 
visited him with madness. The three daughters of Praetus, Lysippe, 
Iphinoe, and lphianassa, are fabled to have become insane in consequence 
of neglecting the worship of Bacchus. They ran about the fields, believ- 
ing themselves to be cows. Praetus is represented to have applied to 
Melampus to cure his daughters of insanity, but refused to employ him 
when he demanded a third part of his kingdom as a reward, reminding 
us of the enormous sums received by Willis for his attendance on George 
III and the Queen of Portugal. This neglect of Praetus was punished, 
and madness became contagious among the Argive women. The persons 
affected, however, as also the daughters of Praetus, were restored on 
Melampus being feed in a more liberal manner. Athamas, King of 
Thebes, and Ino, his second wife, were both said to be insane. Medea. 
the niece of Circe, Cambyses, Clomenes, King of Sparta, and many others 
might be mentioned. Hippocrates makes many allusions in his writings 
to mania,' melancholia, and epilepsy. He says that men ought to know 
that from nothing else but thence (the brain) come joys, despondency, 
and lamentations. By the same organ we become mad and delirious; 
and fears and terrors assail us, some by night and some by day. 

Diocles (B. C. 300) and Asclepiades also discuss this subject in their 
writings, and the Roman poets frequently allude to it. Persius and 
Juvenal both speak of hellebore as a remedy for madness. 

Prom the foregoing extracts we learn that the causes of insanity were 

* See Bucknill & Tuke on Insanity. 



88 

supposed to be very different in the olden time and at the present day. 
We might therefore very naturally expect a different mode of treatment 
corresponding with the pathological opinions of the two periods. This, 
to a certain extent, is true, yet it will be interesting to the non-profes- 
sional reader to learn how this fearful malady was treated by the doc- 
tors of that day. It is a remarkable fact, as we learn from Bucknill & 
Tuke, that some of them at least were as earnestly opposed to the use 
of mechanical restraint as were Pinel, Charles worth, Hill, or Conolly, 
who immortalized their names in the seventeenth century by advocating 
in theory and carrying out in practice the non-restraint system that has 
done so much to ameliorate the condition of the insane in the asylums 
of the present day in most of the enlightened countries of the world. 
Bleeding, so much in vogue at a later day, was also condemned by one 
at least of these celebrated men, as we will see by the following: 

OPINIONS OF ANCIENT MEDICAL WRITERS ON THE TREATMENT OF THE INSANE. * 

Music is the first recorded remedy employed, so far as we are aware, 
for the relief of madness. That ancient musician of whom it has been 
said that he struck tones that were an echo of the sphere harmonies, 
"took an harp and played with his hand; so Saul was refreshed and was 
well, and the evil spirit departed from him." Music appears to have 
been strongly recommended by Asclepiades. 

Asclepiades was certainly one of the most definite in his directions in 
regard to the treatment of the insane. As we have already said, he pre- 
scribed music. He especially recommended that the patient should 
abstain from food, drink, and sleep, in the early part of the day; that in 
the evening he should drink water, that .then gentle friction should be 
applied, while later still, liquid food should be given, with a repetition 
of the frictions. By these means sleep was supposed to be induced. He 
regarded as worse than useless the application of narcotic fomentations, 
referring specially to hyoscyamus, mandragora, and poppies. Such 
reference to these remedies is interesting, as showing their use prior to 
the time in which he flourished. He directed that the patient should be 
placed in the light. To employ bleeding, was, he thought, little short 
of madness. According to Cselius Aurelianus, Asclepiades ordered his 
patients to be chained. Feuchtersleben in his Medical Psychology, 
states that Asclepiades recommends "that bodily restraint should be 
avoided as much as possible, and that none but the most dangerous 
should be confined by bonds; " referring to Celsus and Cselius Aurelianus 
as his authorities for the opinions of Asclepiades, whose works are lost; 
but neither of these writers appears to assert so much. Themison, 
another disciple of Asclepiades, and who is often regarded as the real 
founder of the School of the Methodici, styled " phlebotomotos " by 
Cselius, followed, to a considerable extent, in the steps of his predeces- 
sor as regards treatment; but prescribed the bath and more liberal 
regimen, and ordered astringent fomentations (constrictira fomenta). 

The treatment recommended. by the celebrated Celsus, in his chapter 
entitled, De tribus insanice generibus, may next be • considered. On the 
whole, the directions of this physician are harsh, and scarcely merit the 
praise which some authors have bestowed upon them. It is true, that 
he admits, in regard to those who ramble in their discourses or attempt 

* Bucknill & Tuke on Insanity. 



89 

some trifling injury with their hands, that it is unnecessary to employ 
any rough, coercive measures. He deemed it proper, however, to subdue 
those who were more violent by a very compulsory treatment, " lest 
they should injure themselves or others." Their audacity must be 
coerced, and they must be brought to submission by blows, as in the 
case ©f any one else who requires restraint. Excessive mirth must be 
checked by scolding. If conciliatory measures fail, patients must be 
cured by some kind of torment; thus, should they be detected in false- 
hood or deceit, they must be hungered, or bound in chains, or flogged. 
By these means, he assures us, they will before long, through the influ- 
ence of fear, be thoroughly disposed to come to terms, to eat anything; 
and even their memory, he says, will thus be refreshed. For to startle 
them suddenly, and greatly to terrify them, is profitable in this disease; 
anything, in short, by which the mind is violently disturbed. To close 
up all the avenues of pity this humane physician also says that you are 
not to believe anyone who thus subdued, while he is desirous of being 
released from his bonds, pretends that he is sane, however prudently 
and piteously he may converse, since this very deceit is the result of 
madness. On which enlightened principle it is difficult to understand 
how Celsus himself would have escaped had he once been so unfortunate 
as to be suspected of insanity. Celsus by no means, however, over- 
looked all medical treatment. He approved of venesection, and of cup- 
ping applied to the head, which, he observes, will have the effect of 
inducing sleep. Should any symptom render bleeding unsuitable, the next 
best remedy is abstinence, followed by an emetic and a purgative of 
white hellebore, and if possible the employment of friction twice in the 
.clay. He is here speaking of those cases in which sadness appears to be 
the result of black bile. No longer under the influence of apprehension 
from the violence of the patient, Celsus directs that fear should be 
removed from his mind, and cheerful hopes excited; pleasure being 
sought in fables and sports, and whatever else may be conducive to 
health. Patients are to be judiciously encouraged in their several occu- 
pations, and their groundless fears are to be lightly reproved. Cold 
water is also to be poured upon the head of the patient, and his body 
immersed in water and oil. In maniacal cases, warm fomentations might 
be applied to the shaven head; when, in consequence, the febrile symp- 
toms abate, we are to have recourse to friction; but we must use it more 
sparingly in those cases in which the patients are exhilerated than in 
those in which they are depressed. In the maniacal paroxysm itself, 
however,. Celsus had not much faith in medical aj)plications; indeed, he 
was afraid that by such means the fever would be increased. There- 
fore in such cases, says he, do nothing with the patient but confine him. 

Severe as was Celsus upon the insane, who were guilty of deception, 
he had no hesitation in employing similar means towards the patient, 
We need not quarrel with the direction, that should the patient refuse 
to swallow the doctor's favorite hellebore mixture he is to be deceived by 
having it mixed in his food; but we may well dissent from the pro- 
priety of another direction, namely: that should it be necessary to 
inspire fear, and should the patient be a rich man, you are to announce 
to him the false intelligence of a lost estate. 

The good effect of a full diet in some cases of insomnia was very 
properly pointed out. Other somniferous remedies prescribed by Celsus 
were friction, exercise after food, and by night the sound of a waterfall, 

12 



90 

but chiefly the rocking motion of a suspended bed. ISTor were the sooth- 
ing influences of music in melancholy overlooked. The mind was also 
to be called forth in some cases by reading aloud, and occasionally errors 
might be made in order to elicit the critical powers of the patient. 
Cselius regarded it as essentially necessary to place the maniacal in a 
room moderately light and warm, and to avoid everything of an* excit- 
ing character. Pictures were not to be allowed, nor was the window to 
be too high, nor was the room to be in the upper story, the reason being- 
added that many when seized with madness have thrown themselves 
out. The bed was to be firm, and so placed that the patient could not 
be disturbed by the sight of persons entering the room; it was to be of 
straw, soft, and well beaten, but not broken. If the patient was in dan- 
ger of injuring himself, soft wool moistened was applied to the head, 
neck, and chest; thus instead of having a padded room Cselius padded 
his patient. The duty of attendants, in regard to deception, is clearly 
laid down. They were to beware on the one hand of seeming to con- 
firm the patient's delusions, and thus increase his disorder, and on the 
other they were to be careful not to exasperate him by too much oppo- 
sition, but at one time by indulgent condescension, at another by insinu- 
ation, endeavor to correct his delusion. Should the patient attempt to 
escape and be with difficulty restrained or exasperated with seclusion, 
then, says Cselius, with admirable perception, you must employ more 
attendants. Let these, he adds, without the patient perceiving the real 
object in view, engage themselves in applying friction to his limbs. 
Further: should this treatment fail, and the violence be great, a ligature 
may be resorted to, being quietly applied, and the limbs protected by 
wool. Should the patient have been accustomed to submission and re^ 
erence, this, he observes, will not require frequent repetition — for such 
repetition would induce contempt, and when patients do not yield to 
such a course of treatment, then it becomes necessary to subdue them 
by inducing fear or awe. Should the patient's eyes be affected by the 
light, they must, according to our author, be shaded; but, he adds, with 
great discrimination, in such a way that other parts of the body may 
not be deprived of light. Cselius directed that abstinence from food 
might be carried so far as to induce slight hunger, adding that the 
strength may be reduced by bleeding, if the malady require it, even 
during such abstinence should there be nothing present to contra indi- 
cate it. The food was to be light and digestible, as bread softened in 
warm water, or a preparation of wheat lightly boiled with honey, etc. 
Alternate days of fasting and feeding were likewise recommended. 
Benefit also might be derived from clysters, and the application of an 
emollient cataplasm to the region of the heart. 

Should the disorder become stationary, Cselius advises the head to be 
shaved, and cupping to be applied, first over the chest, then between the 
shoulders ("for these parts sympathize with the head"), and next to 
the head. A restless and sleepless condition was to be relieved by 
carrying the patient about on a litter or in a chair. To this was to be 
added the monotonous sound of running water. Fomentations, by 
means of warm sponges, were to be applied over the eyelids, with the 
idea of relaxing them, and in the hope of exerting a curative influence 
over the meninges of the brain. As reason returned, moderate exercise 
was strongly recommended — riding, walking, and exertion of the voice. 
The patient was to read compositions containing inaccuracies, in order 
the better to exercise the understanding; but Cselius adds a caution that 
this must not be too difficult, lest the patient be overdone with laborious 



91 

mental exercise, which were as detrimental to the mind as immod- 
erate exertion to the body. Theatrical entertainments were to follow 
for those laboring under melancholy, and scenes of a solemn or tragic 
character were to counteract excessive hilarity and excitement. 

Subjects of disputation might be added as the patient recovered, con- 
ducted in a low tone of voice, the preference being given to narrative 
and demonstrative subjects. Further, individuals known to the patients 
were to be employed to converse with them, in a manner calculated to 
encourage and amuse them. These various mental exercises were to be 
followed by rubbing with oil, and a gentle walk. Here, our author 
suddenly remembers that much of the preceding treatment could not be 
carried out with the illiterate; for such, he prescribes questions having 
reference to their particular callings; as, on farming, for the agricul- 
turist; navigation, for the sailor; and for those ignorant even of these, 
questions of a general nature must be propounded. Shampooing, as 
well as inunction, was an important remedy with Ca3lius, including 
frictions of the head. The diet was to be improved as the patient's 
health returned, wine being forbidden in the first instance, gradually 
allowed after the use of fruit, but then only of light quality. 

As the mind recovered its tone, the patient was allowed to go and 
hear the disputations of the philosophers, from the persuasion that the 
passions of grief, fear, and anger were thus dissipated. If, on the con- 
trary, the patient relapsed, the former treatment was to be resumed, 
adding exposure of the body to the heat of the sun, the head being- 
covered. The administration of an emetic made from the root of white 
hellebore, was to be added, to which, if the patient objected, vomiting 
was to be promoted by tickling the fauces. The ears were to be injected 
with water containing a little nitre, honey, nettle seed, or mustard; the 
rationale given being, that even through the channels of the senses, 
a restorative virtue may be conveyed to the membranes of the brain, 
especially as patients are often affected with tinnitus aurium. Finally, 
the cure of the patient was to be established by travelling and sea 
voyages. 

After thus stating the mode of treatment which recommended itself 
to his judgment, Cselius proceeds to condemn the practice of some who 
had preceded him. Some of the Methodici, he observes, have recom- 
mended close confinement in a dark room, forgetting that the patient's 
dislike to it may aggravate his disorder, and that too much seclusion 
from the air causes dense bodies to perspire, and that the omission of 
ordinary occupations will aggravate cerebral congestion. He then 
denounces the extreme abstinence which was recommended, in forgetful- 
ness of the fact that such a course disorders the bodily powers and is 
one which the patient will be unable to bear. The supporters of such 
regimen referred to the taming of wild beasts as analogous and as a 
proof that madness may be thus repressed; but Cselius, anticipating the 
practice of the present day, states that they should have known better 
from a consideration of the effect of hunger upon the sane in inducing 
rage. He does not hesitate to assert that the starving system will 
induce madness rather than cure it. He then refers to a subject of 
especial interest to us in our time, and his observations are calculated to 
humiliate us, exhibiting, as they do, a far seeing philanthrophy which 
those who have treated the insane have, until very lately, failed to imi- 
tate. Cselius observes that they also order the patients to be bound 
with chains, without any consideration that the bound parts must neces- 
sarily be chafed, and how much more properly the patients might be 



92 

restrained by the care of attendants than by senseless chains. He is 
alike indignant against those who would coerce by flagellation, especially 
about the face and head, which, so far from relieving the disease, only 
induces swellings and sores; in addition to which, the returning con- 
sciousness of the patient could not but be hurt by the sense of his 
wounds. 

In regard to the relative advantages of cold and warm applications, 
Cselius speaks of those who endeavor to induce sleep by warm fomen- 
tations of poppy, thyme, roses, etc., and observes, in accordance with 
the view attributed by Cselius to Asclepiades, that the result is heavi- 
ness of the head, but not sleep — constriction being induced, when relaxa- 
tion is required. He then refers to an opposite school who made use of 
cold applications, believing the disorder to be caused by heat; ignorant, 
he observes, that internal heat is an undoubted sign of congestion, and 
not, as they think, the cause of the disease. He condemns the hydro- 
pathic treatment as being calculated to increase congestion, and there- 
fore to aggravate the patient's disorder. In regard to the important 
question of venesection in mania, Cselius comments upon the practice of 
those who employed excessive bleeding from both arms to the extent of 
syncope and even death, and observes that the abstraction of blood from 
both arms is not to be practiced in consequence of the fearful prostra- 
tion of strength which may follow. Clysters he regarded as worse than 
useless, often inducing dysentery in consequence of the active ingre- 
dients which they contained. Among the many strange and opposite 
modes of treatment to which the insane have been subjected, intoxica- 
tion was not overlooked. Some, our author observes, recommend intoxi- 
cation, since madness is often caused by it; but without sufficient dis- 
crimination, since injudiciously used it may prove injurious. ^The plea- 
sures of love, which were prescribed by Titus and Themison, were 
strongly condemned by Cselius, who regards as impious and absurd the 
attempt to indulge propensities which required restraint. 

In the chapter which treats of melancholy, Cselius observes that the 
treatment is the same as has been already prescribed for the maniacal. 
He would not bleed, nor depress the patient by purging him with helle- 
bore and aloes, but at once soothe and invigorate him by emollient and 
astringent applications. The celebrated Galen, of Pergamos, nourished 
at a period but little subsequent to Caalius Aurelianus. He is said to 
have died at the age of ninety, A. D. one hundred and ninety-three. 
His treatment was based upon the humoral pathology, which was in 
such high repute among the ancients, and which exercised an almost 
universal influence on their practice. He lays it down that, if moisture 
produces fatuity and dryness sagacity, just in proportion to the excess 
of moisture over dryness the sagacity will be diminished. Hence, he 
advises the practitioner to aim above all things at preserving a just me- 
dium between these opposite qualities. He recommends that " should 
you be of opinion that the whole of the patient's body may contain mel- 
ancholy blood " you are to employ venesection, especially from the median 
cephalic vein. He adds, that should the blood flowing from it not appear 
to be of a melancholy quality, the vein must immediately be closed; and 
that should the contrary be the case, you are to abstract as much blood 
as the state of the patient and his habit of body shall permit. If, how- 
ever, madness arise from idiopathic disease of the brain, bleeding is by 
all means to be avoided. In forming an opinion on this subject, regard 
was to be had to the patient's constitution and temperament. The fat, 
the fair, and the flabby were not to be supposed to possess any melan- 



93 

choly humor ; but the lean, dark, and hairy, and those in whom the veins 
are large, are the most subject to its accumulation. He gives a long 
enumeration of the kinds of food which induce melancholy, as the flesh 
of oxen, goats, but especially asses and camels, and also wolves, dogs, 
hares, and snails. Among herbs, the cabbage only is mentioned. Thick 
and black wine was to be particularly avoided, " as from it the melan- 
choly humor is made." This melancholy humor is spoken of by Galen 
as a condition of blood " thickened, and more like black bile which, in- 
deed, exhaling to the brain, causes melancholy symptoms to affect the 
mind." We frequently also notice, he observes, that when yellow bile 
is contained in the stomach, the head is painfully affected; but it imme- 
diately recovers when the stomach is relieved from bile by vomiting. In 
mild cases of insanity Galen prescribed the bath and nourishing food. 

IN THE MIDDLE AGES. 

We have thus taken a hurried glance at the opinions of the ancients 
with regard to the pathology of this mysterious disease, and of the 
treatment employed by them for its cure or amelioration, and it is 
strange, indeed, that we hear but little more of it until about the period 
of the reformation. It is true that an asylum is said to have existed at 
Jerusalem about the fifth century, but little seems to be known of its 
character, history, or the modes of treatment employed. Again, at a 
period assigned by tradition, about eleven centuries ago, the tragic death 
of the Irish girl, the Princess Dymphna, who was slain by the hand of 
her own father, led to the establishment of a church and altar at Gheel, 
in Belgium, where those afflicted with u minds diseased " were carried to 
intercede with the spirit of the patron saint for relief; and a number of 
these unfortunate victims, more or less numerous, are supposed to have 
been kept there ever since; till now it has grown into one of the most 
remarkable institutions for the insane that anywhere exists. 

The next asylum established, so far as we are able to ascertain, was 
that of " Eeinier Yan Arkel," at Bois le Due, in Holland. It bears the 
name of its philanthropic founder, who established it in fourteen hun- 
dred and forty-two, for the care and custody of six unfortunate persons 
who had been deprived of their reason. From this small beginning, it 
has continued to increase, till it now has capacity for six hundred 
patients; but on the first of December, eighteen hundred and seventy, 
three hundred of its inmates were removed to a new asylum, just 
finished, a short distance from the city. At the time of our visit — 
seventh of July, eighteen hundred and seventy-one — there were one hun- 
dred and seventy men and one hundred and fifty-six women within its 
walls. The old asylum is immediately on one of the business streets of 
the city, and has been so often added to and enlarged that it can be said 
to possess no particular plan. It still retains many evidences of the age 
in which it was built, and shows more clearly than anything we have 
elsewhere seen, the wonderful and beneficent improvements that have 
been made in the character of the buildings for the treatment of the 
insane. Small dark cells, with high small windows, and cribs in which 
to cage the excited patients, may still be seen, and we regret to say have 
not yet been entirely abolished in this and one or two other asylums 
visited on the continent. The douche, solitary confinement, and confine- 
ment to the chair, are also used in some cases, not as a part of the treat- 
ment, but for punishment — showing how difficult it is even yet, in some 
countries, to shake off old habits and adopt new ideas in the treatment 



u 

of the insane. The inquiring mind of the young and intelligent physi- 
cian, Dr. Frijbank, will doubtless soon lead him to discard all of these 
old appliances, and to adopt the more htfmane and enlightened practice 
of the age in which he lives. Indeed, it is but just to say that he has 
already done so in most respects. 

As another link in the history and treatment of this malady, the fol- 
lowing extracts will show the condition of the insane in asylums in the 
eighteenth and nineteenth centuries: 

IN ENGLAND. 

" The reader of Cselius Aurelianus cannot but feel astonished when he 
finds that nearly eighteen hundred years after that humane physician 
flourished it could be said in the House of Commons, by the Earl of 
Shaftesbury (then Lord Ashley), that the whole history of the world, 
until the era of the Reformation, does not afford an instance of a single 
receptacle assigned to the protection and care of these unhappy suffer- 
ers, whose malady was looked upon as hardly within the reach or hope 
of medical aid. If dangerous, they were incarcerated in the common 
prisons; if of a certain rank in society, they were shut up in their 
houses, under the care of appropriate guardians. Chains, whips, dark- 
ness, and solitude were the approved and only remedies. 

" It is, indeed, to be feared that the directions of Celsus have exercised 
a most prejudicial influence, even till within a very recent period; and it 
is not difficult to recognize them in the writings of the classical Cullen, 
who did not omit to recommend the employment of 'stripes' in the 
treatment of the maniacal. 

" The kind of treatment pursued by the highest medical men four hun- 
dred years ago is pretty clearly indicated by what has been handed 
down to us relative to the psychological history of King Henry VI, in 
whom mental disease was hereditary. Thus we are informed that five 
physicians and surgeons were appointed to attend the royal patient, and 
were empowered to administer ' electuaries, potions, and syrups, confec- 
tions and laxative medicines, in any form that might be thought best; 
baths, fomentations, embrocations, unctions, plasters, shavings of the 
head, and scarifications.' 

" It is not a little singular that Bethleni Hospital, which has become on 
various occasions so notorious for its ill treatment of the insane, should in 
the first instance have provided for their care with benevolent intentions, 
and under some favorable auspices. It was in the year fifteen hundred 
and forty-seven that Henry VIII took possession of the monastery or 
hospital of St. Mary of Bethlem, and presented it to the City of London, 
with an order that it should be converted into a house for the recej)tion 
of lunatics. It was situated in Bishopsgate Ward, without the city wall, 
between Bishopsgate street and Moorfields. Stow describes it in his 
time as standing in an obscure and close jolace in the neighborhood of 
many common sewers, and as also too small to receive and entertain the 
great number of distracted persons, both men and women, who stood in 
need of it." 

In consequence of the want of further provision for lunatics in London, 
a large building was erected in sixteen hundred and seventy-five in 
Moorfields, where the hospital stood until eighteen hundred and fourteen. 
There was, in a short time, accommodation for one hundred and fifty 
patients; whereas, in the old building, there were usually but fifty or 
sixty. In the rules made March thirtieth, sixteen hundred and seventy- 



95 

seven, to which it is interesting to refer, it is ordered inter alia, that such 
of the lunatics as are fit should be permitted to walk in the yard until 
dinner time, and then be locked up in their cells; and that no lunatic 
that lies naked, or is in a course of physic, should be seen by anybody 
without an order of the physician. It is further humanely ordered that 
no officer or servant shall beat or abuse any lunatic, or employ any force 
to them, but upon absolute necessity for the better governing of them. 
Dr. Tyson, who was physician to Bethlem from sixteen hundred and 
eighty-four to seventeen hundred and three, informs us that, as to the 
care and cure of the patients, here is undoubtedly the greatest provision 
made for them of any public charity in the world; each having a con- 
venient room and apartment to themselves, where they are locked up 
at night, and in it a place for a bed, or if they are so senseless as not to 
be fit to make use of one, they are every day provided with fresh, clean 
straw. Those that are fit for it, at convenient hours have liberty to walk 
in the long galleries, which are large and noble. For the Summer time, 
to air themselves, there are two large grass plats — one for the men, the 
other for the women; in the Winter, a stove for each apart, where a 
good fire is kept to warm them. In the hot weather, a very convenient 
bath place to cool and wash them; which is of great service in airing 
their lunacy, and is easily made a hot bath for restoring their limbs 
when numb, or cleaning and preserving them from scurvy, etc. Their 
diet is extraordinary good and proper for them, which every week is 
viewed by a committee of the Governors. * * * There is nothing 
of violence suffered to be offered to any patient, but they are treated 
with all the care and tenderness imaginable. If raving or furious, they 
are confined from doing themselves or others mischief; and it is to the 
credit of the hospital that in so great a number of lunatics that are con- 
stantly kept there, it is very rare, in many years, any one patient makes 
away with himself. * * * The time of cure is uncertain; some have 
been cured in a month, others in two or three, and some continue dis- 
tracted many years." This was written early in the eighteenth century.* 

In seventeen hundred and thirty-four, considerable additions were 
made to Bethlem, and, in consequence of its still proving inadequate to 
meet the demand, Saint Luke's Hospital was established in seventeen 
hundred and fifty-one, by voluntary subscription. It was situate on the 
north side of Upper Moorfields, in a locality called Windmill Hill. 

From this period to the latter part of the eighteenth century but 
little progress was made in the treatment of the insane, and in the con- 
dition of the houses where they were received; indeed, as respects 
Bethlem it is probable that its state had retrogaded rather than advanced. 
In the middle of the century (seventeen hundred and fifty-five) a work 
was published the title of which appears significant, this was " Folly 
Predominant; with a Dissertation on the Impossibility of Curing Luna- 
tics in Bedlam." From time to time during this period a work made its 
appearance on the subject of insanity. Thus, in seventeen hundred, 
Her wig published his "Art of Curing Sympathetically or Magnetically; 
with a Discourse on the Cure of Madness;" and, five years later Fal- 
lowes enlightened the world with his "Method of Curing Lunatics." 

*In the General Regulation of Bethlem Hospital for 1792 we find the following orders: 

" No lunatic shall be put in chains without the instructions or approval of the apothecary. 

" The feet of the lunatics who are chained shall be carefully examined, well rubbed and 

covered with flannels every morning and evening through the Winter; and if any morbid 

symptoms require the presence of the surgeon, he shall at once be informed." — Sections 9 

and 10. 



96 

Blakeway wrote in seventeen hundred and seventeen ( "Essay toward 
the Cure of Eeligious Melancholy,") and Frings in seventeen hundred 
and forty-six (Treatise on Phrensy.) Batty wrote his treatise on mad- 
ness in seventeen hundred and fifty-seven. But none of these works 
deserved or gained much reputation. Perfect, whose first work on the 
subject was written in seventeen hundred and seventy-eight, made some 
valuable contributions to the knowledge then possessed regarding insan- 
ity. His treatment appears to have consisted chiefly in venesection, 
emetics, setons, digitalis, antimony, and electricity. Dr. T. Arnold pub- 
lished the first edition of his excellent "Observations on the nature, 
kinds, etc., of Insanity," in seventeen hundred and eighty-two. This 
work, however, contains little or nothing in regard to treatment. A 
few years afterwards (seventeen hundred and eighty-nine), "A Treatise 
on the real cause and cure of Insanity," was published by Harper, 
which, although it possesses no merit, has, however, the honor of hav- 
ing been criticised by Pinel. In seventeen hundred and ninety appeared 
" Observations on the general and improper treatment of Insanity," by 
Faulkner; and the "Observations on Maniacal Disorders," by Pargeter, 
in seventeen hundred and ninety-two. But none of these writings 
appear to have exercised any material effect in ameliorating the condi- 
tion of the insane in England. This, unfortunately, is but too correctly 
described in the following graphic sketch from the pen of Dr. W. A. F. 
Browne ("What Asylums were, are, and ought to be:") "Let us pass 
a few minutes," he says, " in an asylum as formerly regulated, and from 
the impression made by so brief a visit let us judge of the effects which 
years or a lifetime spent amid such gloomy scenes were calculated to 
produce. The building is gloomy, placed in some low confined situation, 
without windows to the front, every chink barred and grated — a perfect 
gaol. As you enter a creak of bolts and the clank of chains are scarcely 
distinguishable amid the wild chorus of shrieks and sobs which issue 
from every apartment. The passages are narrow, dark, damp, exhale a 
noxious effluvia, and are provided with a door at every two or three 
3^ards. Your conductor has the head and visage of a Carib; carries (fit 
accompaniment) a whip and a bunch of keys, and speaks in harsh mono- 
syllables. The first common room you examine — measuring twelve feet 
long by seven wide, with a window which does not open — is perhaps for 
females. Ten of them, with no other covering than a rag round the 
waist, are chained to the wall, loathsome and hideous; but, when 
addressed, evidently retaining some of the intelligence and much of the 
feeling which in other days ennobled their nature. In shame or sorrow, 
one of them perhaps utters a cry; a blow, which brings the blood from 
the temple, the tear from the eye — an additional chain, a gag, and inde- 
cent or contemptuous expression — produce silence. And if fou ask where 
these creatures sleep, you are led to a kennel eight feet square, with an 
unglazed airhole eight inches in diameter. In this, you are told, five 
women sleep. The floor is covered, the walls bedaubed with filth and 
excrement; no bedding but wet decayed straw is allowed, and the stench 
is so insupportable that you turn away and hasten from the scene." 

" From the evidence given before the memorable committee of the 
House of Commons, in eighteen hundred and fifteen, notwithstanding 
the equivocation and evasion which marked many of the replies, it is not 
difficult to form an estimate of the condition of the English asylums 
generally, more especially the York Asylum and Bethlem Hospital. 
Nor was the condition in which they were found at that period alone 
revealed; their past condition was at the same time rendered manifest, 



97 

"A miserable and empirical routine marked the treatmert. To the 
question: ' Has there not been a rule in the hospital for a certain number 
of years that, in certain months of the year, particular classes of the 
patients should be physicked, bled, bathed, and vomited at given peri- 
ods? ' the reply from Bethlem was in the affirmative. Twice in the year 
the patients, with few exceptions, were bled. 'After they have been 
bled,' said the physician, in evidence, 'they take vomits once a week, for 
a certain number of weeks; after that, we purge the patients. That has 
been the practice, invariably, for years — long before my time.' 

" In regard to the means of coercion employed, it was stated that the 
patients ' are generally chained to the wall with manacles.' When in- 
quiry was made regarding the use of strait waistcoats, it was replied, ' I 
do not believe there are any strait waistcoats in Bethlem now, or very 
few indeed; they generally use irons.' The objection to strait waistcoats 
was that the patients 'could not help themselves in strait waistcoats; 
they are so exceedingly long in the hospital without being seen by any- 
body, in a dark place; in Winter, from four o'clock to six or seven in the 
morning. If they were in a strait waistcoat they could not assist them- 
selves the least in the world.' When, in the following year, the head 
keeper of Bethlem Hospital was asked : ' Was it not the practice in old 
Bethlem — not in the late gallery, but in the gallery pulled down — for 
eight, ten, or more patients to be fastened to the tables, almost in a state 
of perfect nakedness?' he replied: 'Yes; they used to think they tore 
their clothes all to pieces; some of them would do that.' 'In point of 
fact, were they not fastened to the tables, sitting in a state of perfect 
nudity? ' Answer — ' They used to be so at the table; they were chained 
all around.' " 

With these records of the barbarity and cruelty practiced in the asy- 
lums of England, and so forcibly described in the able work of Bucknill & 
Tuke, from which they have been quoted, we need not be surprised at their 
having been made the basis of a sensational novel by Charles Eead, even 
after they had ceased to exist, nor that the prejudices against these in- 
stitutions should still hold a place in the minds of the people everywhere. 

THEIR CONDITION IN FRANCE. 

Esquirol says of the insane in France: "I have seen them naked or 
covered with rags; with nothing but a layer of straw to protect them 
from the. cold dampness of the ground upon which they lay. They were 
kept upon food of the coarsest kind; they were deprived of fresh air to 
breathe, and of water to quench their thirst, and even of the most neces- 
sary things of life. I have seen them given up to the brutal supervision 
of jailors. I have seen them in their narrow cells, filthy and unwhole- 
some, without air or light, chained in such dens as one might fear to 
confine ferocious beasts." "Similar to these were the abodes of the 
insane throughout Europe." 

IN ROME AND LIMERICK. 

" In Home iron rings, armed with chains, and fixed in the wall, serve 
to confine the furious and turbulent maniacs, who are fastened by their 
necks and feet." "In one room were two rings fixed to the wall; one 
ring was to embrace the neck, the other the ankle, and the poor maniac 
was doomed to stand or suspend himself by the neck." " The accommo- 

13 



98 

dations in the asylum at -Limerick appear to be such as we should not 
appropriate for our dog kennels." " One victim was confined in one of 
the oblong troughs, chained down. He had evidently not been in open 
air for a considerable time, for when I made them bring him out he 
could not endure the light. Upon asking him how often he had been 
allowed to get out of the trough, he said: 'Perhaps once a week, and 
sometimes not for a fortnight.' He was not in the least violent; he was 
perfectly calm."* 

IN THE GERMANIC CONFEDERATION. 

In eighteen hundred and forty-five the Journal Psychiatrie and 
Psychological Medicine was established, with Doctor Damerow, of the 
institution in Halle, as its principal editor, and Doctors Flemming and 
Roller — the latter of the Illenaw Asylum — as associates. Although 
printed at Halle, as a matter of convenience to Doctor Damerow, it is 
published at Berlin. If an opinion may be formed from the vigor with 
which it has been conducted, as well as the long list of collaborators — 
men distinguished as physicians of the insane or for their knowledge of 
psychical medicine and the jurisprudence of insanity, not in Germany 
alone, but in Denmark, Holland, and Switzerland — it will not lack for 
material, and is established upon a permanent basis. Its editor in chief 
is one of the most prominent advocates of the doctrines of the Psycho- 
Somatic school, but both his associates are Somatics. Among its col- 
laborators are found all the gradations of theory from the somatic to 
the psychic. 

Since the death of Heinroth, Dr. Ideler, of Berlin, is the acknowledged 
leader of the psychic school. But as time has progressed the conflict of 
opinion has measureably subsided. The attention of physicians has 
been diverted from the comparatively barren field of hypothetical con- 
troversy to the more useful domain of practical science, the improve- 
ment of hospitals, and the treatment of their inmates. 

From the foregoing historical sketch, chiefly of the literature of 
insanity, it may be justly inferred that little, if anything, was done 
during the last century for the improvement of the receptacles for the 
insane in Germany. The initiative, however, was taken even in the few 
writings which were published, as these were the preliminary steps 
which led to more important practical action. The asylum at Vienna, 
but of late years not very favorably known as the Narrenthurm, was 
completed and opened in seventeen hundred and eighty-four, and was 
at that period the best establishment of the kind, as it was the only one 
exclusively devoted to the insane, throughout the German nations. As 
the eighteenth century was departing, Heinroth, having finished his 
studies at Paris, carried the principles of his illustrious preceptor within 
the German borders, and thus added a new and important element to the 
cause of improvement. An idea of the condition of the German asylums 
at the commencement of the present century may be derived from the 
language of one of their native authors, Reil, who, in his " Rhapsodies 
upon the application of the Psychical Curative Treatment in Mental 
Disorders," published in eighteen hundred and three, wrote as follows: 
" They are mad-houses, not merely by reason of their inmates, but more 
especially because they are the very opposite of what they were intended 
to be. They are neither curative institutions nor such asylums for the 

* Browne's Lectures, Edinburgh, 1837. 



99 

incurable as humanity can tolerate; they are for the most veritable dens. 
Has man so little respect for the jewel which makes him man, or so 
little love for his neighbor who has lost that treasure, that he cannot 
extend to him the hand of assistance and aid him in regaining it? Some 
of these receptacle are attached to hospitals, others to prisons and houses 
of correction; but all are deficient in ventilation, in the facilities for 
recreation; in short, they are wanting in all the physical and moral 
means necessary to the cure of their patients."* 

OBSERVATIONS UPON FOREGOING SUBJECTS. 

The foregoing extracts from various well known authorities have been 
made not only to show the condition of the insane, the character of the 
establishments in which they were kept, and the methods of treatment 
adopted and pursued in such cases by the most learned and eminent 
men in the several countries under consideration, but also to direct 
attention to the fact that though sundry efforts had been made by men 
of learning and ability to establish journals of mental science in Ger- 
many during the latter part of the eighteenth and early part of the 
nineteenth centuries, they all signally failed, not from lack of ability on the 
part of those who edited and conducted them, but for want of support by 
the public. The first of these magazines was commenced in seventeen hun- 
dred and eighty -three, but lived only a short time. The next periodical 
devoted exclusively to the subject of insanity was established by Doctor 
Eeil, and published at Halle, in Prussian Saxony, in the year eighteen 
hundred and five, the philosopher Kayssler having contributed largely 
to its pages. It, too, soon shared the fate of its predecessor, and died 
for the want of appreciation and support, too little interest as yet being 
felt in a class of persons supposed to be possessed by devils. In 
eighteen hundred and eighteen Nasse made another effort, and com- 
menced his Journal of Psychological Medicine, and being conducted with 
great ability and unusual zeal, awakened a more lively interest in the 
subject and its unfortunate victims. But the time for success had not 
yet arrived, and after a desperate struggle for eight years it, too, went 
down to join the list of the departed. Still another journal was started 
in eighteen hundred and twenty-nine; and yet another, by Doctors 
Jacobie and Flemming, in eighteen hundred and thirty-eight, but all 
with similar results. Many valuable essays and books have in the mean 
time been given to the world by various German writers; but it was not 
till eighteen hundred and forty-five, as already stated, that a journal 
was established, with Damerow of Halle as its head, and Flemming and 
Poller — the latter still at Illenaw — as assistants, that a psychological 
journal has been able to stem the current and stand the test of time. 

Since that time many able writers have appeared upon the field of 
psychological medicine and made valuable contributions to • science. 
Among these, none stood higher either at home or abroad than the 
lamented Griesinger, who has left behind him in his works a monument 
more grand, beautiful and enduring than any that could be erected of 
marble or bronze. 

It is also worthy of notice that there was but one public asylum in all 

^Institutions for the Insane in Germany, by Pliny Earle, M. D. 



100 

Germany in seventeen hundred and eighty-four* — the " Norrenthurm " 
at Vienna — while at the present time, as will be seen in the list of asy- 
lums, in the German Confederation ,| there are ninety-two public and 
forty-nine private institutions devoted to the care and maintenance of 
this hitherto neglected class of human beings. And although most of 
these do not come up to our ideas of first class asylums, as viewed from 
an American or English standpoint; nevertheless, some of them are well 
built, conveniently arranged and ably conducted, and would be a credit 
to any country. Indeed, it may be said that very nearly all of those 
established within the last twenty years are of this class. 

CRUEL TREATMENT THE RESULT OF IGNORANCE. 

It would appear strange indeed, and, if we did not know to the con- 
trary, absolutely incredible, that such cruelties, such barbarous practices 
as have been noticed in the foregoing pages could have been tolerated for 
so long a time among the refined, intelligent, and highly civilized people 
of Europe without a single effort — previous to the French revolution — 
on the part of humanity to relieve the distresses of this class of their 
fellow creatures. Ignorance, in law, is no excuse, and yet ignorance is 
the only excuse that mankind can offer for the neglect of these wretched 
creatures. They were regarded during these long centuries as being 
possessed of devils, as enemies of society, and as doomed forever, so 
soon as they were known to be madmen. Even yet this idea has not 
been eradicated from the minds of some people, while many still believe 
the disease to be incurable from the beginning, and its accession a dis- 
grace to the unfortunate victim and his family. It is high time for the 
people to lay aside these false notions, and accept the fact that insanity 
is simply the effect of a diseased brain, and that all persons are liable to 
its invasion. 

NEW YORK POORHOUSES. 

But let us look into this matter at home, and see if we cannot find that 
these abuses and cruel practices, unfortunately, have not been confined 
to English and continental institutions. The following extracts will 
show their condition in the poorhouses of New York at a comparatively 
recent period. In eighteen hundred and fifty-seven a committee, consist- 
ing of Mark Spencer, George Bradford, and M. Lindley Lee, reported the 
results of inquiries and examinations made the Summer before. The fol- 
lowing sentence is from that report: 

" The poorhouses throughout the State may be generally described as 
badly constructed, ill arranged, ill warmed, and ill ventilated. The rooms 
are crowded with inmates, and the air, particularly in the sleeping apart- 
ments, is very noxious, and to casual visitors, almost insufferable." 

In eighteen hundred and sixty-five a Committee of which Dr. Sylvester 
D. Willard was Chairman made a report, from which we extract the fol- 
lowing: 

*Note. — The Alexianer Convent at Aix-la-Chappelle has been a receptacle for the insane 
for five hundred years; and the " Bloekdick" (private asylum), near Bremen, was estab- 
lished in 1750, and rebuilt in 1839. 

tSee Appendix B. 



101 

" It is not without a confession of pain and humiliation that the Com- 
missioners announce the deplorable condition of the insane poor; the 
' notorious and sickening abuses ' which they found in many of the public 
establishments known as County Poorhouses. With unquestionable truth 
they affirm that ' the State has shifted off from itself upon the counties a 
duty which it ought ever to have recognized as imperative and sacred.' 
Nearly every county house was visited. As the record of particular 
instances is more convincing and more affecting than general statements 
and summary conclusions, a few facts are condensed from the report, the 
selection being made from counties in the Hudson River hospital district. 
Let us look first at Albany. Here, under the shadow of the State Capi- 
tol, were seventy-six insane persons shut up in thirty-one rooms, each of 
which was intended and is only large enough for one. A number of 
these rooms had three occupants in each; the ventilation in some of 
them was very imperfect. Notwithstanding the deficient accommoda- 
tions, rendering all classification impossible, recent cases are frequently 
received and held for treatment, with what probability of improvement 
under such conditions can easily be seen. The insane poor of Duchess 
County are bestowed in eighteen cells constructed in prison style, with 
heavily grated doors and barred windows; board partitions separate 
these cells, and wooden bunks serve for bedsteads; for want of proj)er 
appliances the cells cannot be made comfortable in cold weather; two of 
the men were loaded with chains. For her insane Richmond County has 
provided four dark cells. One poor creature has spent fourteen years in 
a small outhouse — a cripple, bent nearly double — and without a rag of 
clothing! The poorhouse in Saratoga County is nearly fifty years old; 
the floors and walls of this venerable structure are much broken, and 
the roof leaks. Though not far from the Ballston Springs, the water is 
scarce there. The cells of the insane measure seven and a quarter by 
six and a quarter feet, and each contains a wooden bunk, and nothing 
else ; these cells get all their light and air through gratings in the doors ; 
in these dungeons individuals have been confined for ten and even for 
eighteen successive years, never going outside, except during the short 
annual visits of the Board of Supervisors. In one case there had been 
an illegitimate birth, under circumstances most distressing and revolting. 
Warren County is thus described: 'Insane filthy in their persons, and 
stench from the place intolerable. Four cells in the building, all unfit 
for use. Rats the only scavengers. No medical attendance. Building 
entirely unsuited to the purpose.' " 

Very little is said in praise of Franklin, Essex, Washington, Greene, 
Putnam, Sullivan, Westchester, and Queens Counties. At the time of 
the inspection the number of insane persons who were shut up in cells 
or secured by chains was two hundred and thirteen. In view of the 
whole picture the Commissioners might well exclaim: "Will the people 
of New York, when they comprehend the inhuman treatment which the 
insane poor sometimes receive, leave a system in unchecked operation 
which admits of such enormities?" 

We are rejoiced to say that the people of New York have compre- 
hended this subject, and have nobly responded to this question in a 
manner not to be mistaken, and with a generosity worthy of that great 
State. Her legislators, advised and encouraged by her wise executive 
officers, have made appropriations, provided lands, selected sites, and 
ordered the erection of asylums for the proper care and treatment of 
every insane person within her borders. 



102 

AMELIORATION IN THE TREATMENT OF THE INSANE AS COMPARED WITH 

FORMER PERIODS. 

Let us call attention for a moment to some of the causes that led to 
an amelioration of the condition of the insane, both in England and on 
the continent, and to some of the men who were conspicuous in directing 
public opinion in so important a matter, and instrumental in carrying out 
the humane doctrines they proclaimed. A brief review of the life and 
writings of Dr. Conolly appeared in the American Journal of Insanity 
for April, eighteen hundred and seventy; a few extracts from which will 
subserve the purposes we have in view: 

Former Coercive Treatment. 

Few of us in America know, except from history or from travel on 
the continent, the extent to which mechanical restraints were used in 
Great Britain previous to eighteen hundred and forty, and are now in 
the other European countries. 

Dr. Conolly found on taking charge of the Asylum at Han wells — 
eighteen hundred and thirty-nine — each ward provided with a closet full 
of restraining apparatus, and every attendant used them at will. Many 
patients were always in restraint. Six new restraining chairs had been 
recently added to the stock, making forty-nine in all (pp. 53, 54). The 
instruments of mechanical restraint were so abundant as to amount, 
when collected together, to about six hundred; half of them handcuffs 
and leg locks (pp. 18, 20). 

This may be assumed as a specimen .of the provision in the asylums of 
Great Britain and Europe at that time, and these means nearly repre- 
sented the ideas of the people at large, the governors or magistrates 
who had the outer superintendence of these establishments, and the 
physicians who had them under their immediate charge. 

Pinel. 

Although Pinel had wrought what was deemed almost miracles in set- 
ting the manacled maniacs free without evil consequences to those who 
were in contact with them, yet few had dared to follow him, and the 
lunatic remained in great measure as he was before. The world still 
clung to the faith of olden time — that the insane were the devil's pos- 
sessions, and those thus possessed should be, if not punished, at least 
restrained, to prevent injury to the fearful community. 

Treatment in Middle Ages. 

Nevertheless, there had been a wonderful improvement upon the cruel 
customs of the barbarous ages. In those dark periods the religious 
houses were in some sort used as hospitals, and some of them took care 
of the insane. At one of these establishments of the Franciscans, who 
believed in and practiced on themselves the severest mortifications and 
self-chastening, the same rule was applied to their patients, and they 
gave each lunatic ten lashes a day. In another each patient was bled 
every June. Stripes, however, were but one form of cruelty, and the 
slightest of the kind. In the old asylums all the most terrible engines 
of torture, to carry out the theory of punishment, were resorted to. 
The inventions to give pain were marvelous. There were chairs of 



103 

restraint in which the patient could not move limb or body, and whirling 
chairs, in which the unfortunate lunatic was whirled at the rate of one 
hundred gyrations a minute (p. 47). 

These and other practices equally cruel were continued in Germany 
as late as seventeen hundred and ninety. In some asylums the patients 
were kept in a state of partial famine, chained, covered with dirt and 
filth, but half clothed, and their insufficient clothing seldom changed; 
cages of iron were in use, in which some of the lunatics were kept for 
years. These miseries were inflicted, not from carelessness, but from 
what was believed to be real humanity (p. 48). 

In an earlier age, some iron cages were made sufficiently large to 
hold one or more patients. These were movable and suspended by chains 
over water, in tanks or pools, with the patients standing in them; they 
were let down into the water, until it reached their chins or mouths, 
leaving them only a breathing place. There they were kept as long as 
they could endure the position and the bath. This was an established 
part of the treatment or punishment. The worst of these practices had 
passed away before the time of Pinel and his followers. 

York Asylum. 

Among the bad, the York Asylum was the worst. A female member 
of the Society of Friends being placed as a patient in this institution in 
seventeen hundred and ninety-one, died under suspicious circumstances. 
They immediately determined to establish an asylum under their own 
control, in which there should be no secrecy. William Tuke was the 
great founder of this new hospital, and from the first he and his associ- 
ates pursued those principles in its management that Pinel was then pro- 
posing, and which have now become the established rule of practice in 
Great Britain and the United States. They did not abolish all restraints, 
yet they began this work, retaining only those of the milder kind. 

Lincoln Asylum. 

Dr. Charlesworth, in the Lincolnshire Asylum, in eighteen hundred 
and twenty-one, began his experiments of substituting the milder for the 
severe restraints. He persevered in this great work year after year, 
regardless of opposition and undaunted by difficulties, and at length 
arrived at the total abolition, which he found both a practicable and a 
more comfortable and successful method of controlling the patient. Mr. 
Gardner Hill was also engaged in the same work, with the same result. 

Dr. Conoi&y at Hanwell. 

Still chains, handcuffs, and leg blocks were in general use in the asy- 
lums of Great Britain and the continerjtal nations when Doctor Conoliy 
entered the Hanwell Asylum) as Resident Physician, on the first of June, 
eighteen hundred and thirty -nine. ,'• He' was familiar with the writings 
and practices of Pinel, Charlesworth,' and Hill. He had confidence in 
the success of these measures and in their applicability to any other 
hospital. At once he determined to try the experiment on the patients 
at Hanwell. 

He began his w T ork June first. There were then over forty under 
mechanical restraint. Immediately he commenced removing the shackles, 
fetters, etc., from those who were the most promising, or who suffered 



104 

most, and proceeded gradually until the whole were removed in less than 
four months. In his work on the treatment of the insane he quotes 
from the asylum records: 

"After the first of July, when I required a daily return to be made to 
me of the number of patients restrained, there were never more than 
eighteen so treated in one day. After the thirty-first of July the num- 
ber never exceeded eight; after the twelfth of August it never exceeded 
one, and after the twentieth of September no restraints at all were 
employed." 

On the thirty-first of October, in his first report to the Quarter Ses- 
sions, he said: "Since the twenty-first of September not one patient has 
been under restraint. No form of straight waistcoat, no handcuffs, no 
leg locks, nor any contrivance confining the trunk or limbs, or any of 
the muscles, is now in use. The coercion chairs, about forty in number, 
have been altogether removed from the wards " (p. 20). 

In his eleventh and last report he says: "For ten years no hand or 
foot has been fastened in this large asylum, by day or night, for the 
control of the violent or the despairing; no instrument of mechanical 
restraint has been employed, or even admitted into the wards, for any 
reason whatever; no patient has been placed in a coercive chair by day 
or fastened to a bedstead by night. Every patient, however excited or 
apparently unmanageable, arriving at the asylum in restraints has been 
immediately set free, and remained so from that time. The results, more 
and more seen in every successive year, have been increased tranquility, 
diminished danger, and so salutary an influence over the recent and 
newly admitted and most recent cases, as to make the spectacle of the 
more terrible forms of mania and melancholia a rare exception to the 
general order and cheerfulness of the establishment" (p. 33). 

Effect of Removal of Restraints. 

The effect of this removal of restraints was at once noticed in the 
general tone of the whole hospital. The excited were sooner calmed, 
the irritable less easily disturbed, and a general quiescence prevailed 
more than before. The wards were managed with less difficulty. The 
new system tended to remove, as far as possible, all causes of excite- 
ment from the irritable, to soothe, encourage, and comfort the depressed, 
to repress the violent by methods that leave no ill effect on the temper, 
no painful recollections in the memory, and in all cases seize every 
opportunity of promoting a restoration of the healthy exercise of the 
understanding and the affections (p. 27.) Mania not exasperated by 
severity, and melancholia not deepened by want of ordinary consolations, 
lose the exaggerated character in "5vhich they were formerly beheld. 
Hope takes the place of fear, serenity is substituted for discontent, and 
the mind is left in a condition favorable to every impression likely to 
call forth salutary efforts (p. 28.) l 

Effect of Dr. Conolly^s Method on other Physicians. 

Many physicians, managers of other institutions in Britain, visited 
Dr. Conolly, and a few from the continent. These became converts 
to his views and strong friends of his plans. One asylum after another 
followed him, until, before many years, non-restraint seemed to be the 
universally accepted doctrine of the whole psychological profession in 
England and Scotland. 



105 

Proof of the Advantage of Moral Treatment. 

As proof of the advantage of moral over mechanical means of treat- 
ment, Dr. Broadhurst points to " the general quietness and decorum of 
his establishment, the cheerful aspect of the patients, the comparative 
freedom from acts of destructive violence, the large proportion con- 
stantly engaged in useful occupation, a decreased mortality, and an 
increased percentage of cures." (p. 78.) 

Mr. Wilkes, formerly Superintendent of the Stratford Asylum, now 
Commissioner o-f Lunacy, writes: "The effect of the change upon the 
old inmates was in marked degree beneficial." 

The excitement of the patients generally diminished. They were 
less noisy and restless at night; destructive propensities and objection- 
at#e habits were, in many instances, overcome. With greater oppor- 
tunities of doing mischief, less occurred. And now, without a window 
in any way protected, and a much larger number of patients, there is 
probably less breakage of glass than there ever was. (p. 79.) 

'Refutation of Dr. Conolly. 

He was very much consulted in the cases of the greatest importance, 
and was considered the .chief authority in all matters of doubt. Ever 
affable and courteous, he drew many to his house from his own country 
and from abroad, and alienists from the continent and from America 
found and enjoyed the most cordial hospitality. Several of the psycho- 
logical physicians of the greatest power on the continent were among 
his visitors and became the strongest friends of his doctrine of non- 
restraint. Among these were Doctor Griesinger, of Berlin ; Baron 
Mundy and Meyer, of Germany; Morel, of France; and Guislain, of 
Belgium. 

They used their utmost exertion to introduce the practice into their 
several countries, but, except in the institutions within their immediate 
influence, they made but few converts; and Continental Europe was yet 
to accept the new method and to unchain its lunatics. 

Doctor Conolly 's opinions in regard to the Management of the Insane. 

In the management of the insane he considered the provision of large 
establishments, however desirable as a matter of economy, was at the 
cost of some of the remedial powers of the institution and of the 
chances of restoration of the patients, and that the proper conduct of 
lunatic asylums requires the whole power of mind and heart that belong 
to the superintending physician; and that whenever the governors or 
directors of each institution require their medical officers to leave their 
high vocation and sacred responsibility of watching mental disorders 
and guiding mental weakness, and give their time and thought to the 
subordinate matter of finance and stewardship, to collect bills, and watch 
the market, they take from the suffering patients a part of that influence 
upon which their best hope of recovery is founded. 

Such were the life and character of Doctor Conolly, and such were 
his works, as described by his friend Sir James Clark, and as known, in 
part, to most of us. Few men have fulfilled a nobler destiny; few will 
be remembered with more affection and gratitude. 

14 



106 

KIRKBRIDE ON RESTRAINT AND SECLUSION, AND THE MEANS OF AVOIDING 

THEIR USE. 

Restraint and Seclusion. 

The use of mechanical means of restraint and the protracted seclu- 
sion of patients in their rooms — although the former of them may be, 
and as I believe is, occasionally desirable but not absolutely necessary 
in the management of our hospitals for the insane — ought both always 
to be regarded as evils of no trifling magnitude, and to abate which, as 
far as possible, no effort should be left untried. They both tend to 
produce a relaxation of vigilance, and it cannot be too often repeated 
that whatever tends to make vigilance unnecessary is undesirable about 
a hospital for the insane. Besides leading patients into bad habits,Ahe 
frequent use of the means referred to in a ward induces attendants and 
others to look upon them as a common recourse in cases of difficulty or 
danger, to regard them as their grand reliance in every emergency, and 
to forget the great power of other measures that are entirely unobjec- 
tionable — the value of tact and kindness and sympathy in controlling 
the violence and dangerous propensities of the insane. And yet, with- 
out a proper force of attendants and an efficient classification the use of 
mechanical means of restraint and the protracted seclusion of certain 
classes of patients is almost unavoidable. 

Objectionable as I deem the use of restraining apparatus in a hospital 
for the insane, it cannot be too earnestly insisted on that it is no advance 
to give up mechanical means of restraint and to substitute the frequent 
and long continued seclusion of the patients. Occasionally an individual 
may really be more comfortable and much better off in the open air, 
with some mild kind of restraining apparatus on his person, than he 
would be confined to his room without it; for this kind of long contin- 
ued seclusion is pretty sure, sooner or later, to lead to habits revolting 
in themselves and most unfortunate for the future prospects of the 
patient. 

The subject is introduced here as a reason why no false notions of 
economy should be permitted to influence any Board of Trustees to ask 
the Superintendent of an institution to attempt its management with a 
force so inadequate as to compel him, against his better judgment, to 
resort to means so objectionable, and which are so destructive to the 
comfort and proper treatment of his patients. 

Labor, Outdoor Exercise, and Amusements. 

Having referred to the unfavorable results of an habitual use of 
restraint and seclusion in a hospital for the insane, it is proper to indi- 
cate in more detail some of the means by which those unfortunate effects 
may be obviated. 

A properly constructed building, admitting of a liberal classification 
of the patients, and the employment of an adequate number of intelli- 
gent and kind assistants, is indispensable for such an object. The 
design in establishing every such institution being the restoration and 
comfort of the afflicted, the relief of their families, and the protection of 
the community, there can be no question but that it is sound economy 
to provide everything that will effect these objects promptly and in the 
most thorough manner. 

Without adequate provision for outdoor exercise and occupation for 



107 

the patients, and a liberal supply of means of amusement, the excite- 
ment of the wards and the violent and mischievous propensities of their 
inmates will be apt to be such as to require modes of management that 
might otherwise be easily dispensed with. The first cost of some of 
these arrangements will necessarily be considerable, but the ultimate 
results can hardly fail to be so gratifying as to satisfy the most rigid 
stickler for economy that the only wise course is to provide liberally of 
everything likely to be beneficial to the patients. 

The farm and garden offer admirable means of useful occupation to 
the insane at certain periods of the disease; for, useful as they are to a 
large number, no greater indiscretion could be committed than attempt- 
ing to set all insane men at work in every stage of their malady. 

To those accustomed to such pursuits, as well as to many who have 
been differently occupied, regular, moderate labor in the open fields or in 
the garden contributes most essentially to their comfort and tends to 
promote their recovery. Labor, then, is one of our best remedies ; it is 
as useful in improving the health of the insane as in maintaining that of 
the sane. It is one of the best anodynes for the nervous; it composes 
the restless and excited; promotes a good appetite and a comfortable 
digestion, and gives sound and refreshing sleep to many who would with- 
out it pass wakeful nights. 

The provision of adequate and comfortable workshops, in a convenient 
position and under the care of competent superintendents, may be made 
a source of profit to an institution, and furnish another means of labor 
of an interesting kind to a large number of the insane. 

The usual means of amusement, which demand active muscular exer- 
cise, should not be neglected. A gymnasium, suitable in its fitting up 
for insane men, and a calistheneum for insane women, will be found use- 
ful. The various games of ball; the exercise of using a car on a circular 
railroad; the care of domestic animals, as well as regular walks on the 
grounds or in the neighborhood, are also among the kinds of exer- 
cise that will be enjoyed by many patients; while means of carriage 
riding seem almost indispensable for many, who from physical and other 
causes cannot resort to the more active forms which have already been 
referred to. 

Within doors the means of keeping a comfortable house are, in addi- 
tion to the medical treatment, the constant presence among the patients 
of intelligent attendants, active supervisors, and judicious teachers or 
companions, always ready to check the commencement of excitement, to 
separate quarrelsome individuals, and to change the train of thought of 
those who seem disposed to be troublesome. The means to effect the 
objects in view are very numerous, and the tact of an individual is shown 
in selecting those that are most applicable to a case. 

The introduction of regular courses of lectures, interesting exhibi- 
tions of various kinds, and musical entertainments in the lecture rooms 
of our hospitals for the insane, has done much to break up the monotony 
of hospital life, which is so common a source of complaint among the 
insane. 

Eegular courses of instruction in well furnished school rooms, reading 
aloud by the teachers to the j>atients of the more excited wards, the use 
of well selected libraries, the inspection of collections of curiosities, the 
use of musical instruments and various games, are all among the many 
means which an ingenious Superintendent will suggest for the benefit 
and amusement of his patients, and which ought to be provided for in 
every institution for the insane. 



108 

In most of the asylums in the United States the dance is either added 
to this list or substituted instead of some of its items. It is a favorite 
amusement among the patients wherever it is allowed; and we have been 
informed by some of the Superintendents that patients will often con- 
trol themselves for a whole week with a promise that they may be 
allowed the privilege of going to the next dance. 



CHAPTER IX. 
INSANE ASYLUMS, LOCATION, SIZE, SITES, ETC. 

Location — Influence that Distance ought to have on Location — Effect of Multiplying 
Hospitals — Effects of Kailroads and other Facilities of Travel — Hospitals Better 
Known to Neighboring People — Observations on Foregoing Topics — New York State 
Lunatic Asylums — General Suggestions — Propositions relative to the Structure and 
Arrangements for American Institutions for the Insane — English Lunacy Commis- 
sioners on Sites, Construction, Size, etc. — Suggestions of the Scotch Board — Size of 
Hospitals — Quantity of Land Necessary — Comments upon Kirkbride's Views. 

LOCATION. 

The location of an asylum has, perhaps, as great an influence over its 
usefulness as any other matter connected with its establishment, and 
those to whom this important trust may be delegated, here or elsewhere, 
cannot be too careful with the selection they may make. There are 
certain general rules that should never be overlooked nor disregarded by 
them, as on their action may depend, in a great degree, the success of 
the asylum to be established at the present time, as well as those that 
must, in the progress of events, come after it. 

The admissions in our Asylum during the last ten years was an 
average of three hundred: and fifty-eight each year, and the average 
annual increase has been sixty-seven. If we take a shorter period, 
these numbers will be augmented. We see by the report of Dr. Shurt- 
leff, that "for the past five years the annual admissions have averaged 
about four hundred and fifty, and the net increase has been about 
eighty." With the increasing population, we may estimate with cer- 
tainty that no decrease in these numbers will take place, if indeed, in 
the providence of God, and the better habits of the people, it be per- 
mitted to remain at these figures. This proportion of increase would 
give us eight hundred additional insane persons in the next ten years. 
But let us suppose that insanity will continue in its present ratio to the 
population, or one to four hundred and eighty-nine inhabitants, and that 
the population increases no more in the next decade than during the 
last, and it will be seen that more than eight hundred will be added to 
the regiment of insane men and women already in our Asylum at 
Stockton. It therefore behooves us, in any present provision we may 
make to meet the pressing necessities of immediate demands, to look 
wisely to the future, and so shape our action that it may have its proper 
bearing on similar provision to be made at some subsequent and not dis- 
tant time to come. 



109 

INFLUENCE THAT DISTANCE OUGHT TO HAVE ON LOCATION. 

That the importance of locating an asylum in convenient proximity 
to the greatest number who will be likely to require its use may be 
thoroughly understood and appreciated, we have made the following 
extracts from a Treatise on the Influence of Distance from and Nearness 
to an Insane Hospital on its Use by the People, prepared for the State 
of New York, by Edward Jarvis, M. D. : 

"An insane hospital is, and must be to a certain extent, a local insti- 
tution. People will avail themselves of its privileges in some proportion 
to their nearness to it. No liberality of admission, no excellence of its 
management, no power of reputation can entirely overcome the obstacle 
of distance, expense, and of the difficulties of transporting lunatics, or 
the objection of friends to sending their insane patients far from home, 
and out of the reach of ready communication. 

n The operation of this principle, in some degree, seems probable to 
any one who gives a thought to the matter; but the facts, the particular 
history of those institutions in which the records of the homes of their 
patients are kept, show that the objection of distance prevails with all 
of them, and that those hospitals have been and are used by those who 
live near by much more than by those who live farther off; and conse- 
quently they are practically much more local in their usefulness than 
they are intended or are supposed to be. 

" The State Hospital at Utica was opened in eighteen hundred and 
forty-three, and offered to the people of every county, both near and 
remote, on the same conditions. The people of Oneida, Schoharie, 
Orange, Washington, and Chautauqua, were alike invited to send their 
insane on the same terms. Between 'them there was and could be no 
difference of advantage after their patients should be placed in the hos- 
pital; the only difference was in the distance between their homes and 
the institution, in the labor, cost, and burden of traveling to a hospital 
with a lunatic. To make this matter more certain and to show the dif- 
ference of enjoyment to the eye, the whole State has been divided into 
four districts, according to their distance from the hospital. 

" The First District is Oneida County, in which the hospital is 
situated. 

" The Second District consists of eleven counties: Chenango, Cortland, 
Fulton, Herkimer, Lewis, Madison, Montgomery, Onondagua, Oswego, 
Otago, Schoharie. These are mostly within sixty miles of Utica. 

" The Third District includes seventeen counties, which are from sixty 
to one hundred and twenty miles distant: Albany, Broome, Cayuga, 
Columbia, Delaware, Greene, Hamilton, Jefferson, Rensselaer, Saratoga, 
Schenectady, Seneca, Tioga, Tompkins, Warren, Washington, Wayne. 

" The Fourth District includes the most distant counties, which are 
from one hundred and twenty to three hundred and fifty miles from 
Utica : Allegheny, Cattaraugus, Chautauqua, Chemung, Clinton, 
Dutchess, Erie, Essex, Franklin, Genesee, Livingston, Monroe, Niagara, 
Ontario, Orange, Orleans, Putnam, Queen, Eichmond, Rockland, Schuy- 
ler, Steuben, St. Lawrence, Suffolk, Sullivan, Ulster, Westchester, 
Wyoming, Yates. 

"These four districts include all the counties of the State, except New 
York and Kings, which have each hospitals of their own, and therefore 
little or no occasion or inducement to send patients to Utica. 

" The population of each of these districts has been ascertained and 



110 

calculated for each of the twenty-three years, eighteen hundred and 
forty-three to eighteen hundred and sixty-five inclusive, since the hos- 
pital was opened. The number of patients sent to the hospital from 
each district within that period has also been ascertained. 

" Taking, then, the sum of the annual populations for twenty-three 
years, and dividing it by the number of patients sent in that time, shows 
the proportion of patients which each district has sent out of its whole 
number of people. These numbers and facts are presented in the fol- 
lowing statement: 

" For these twenty-three years — eighteen hundred and forty-three to 
eighteen hundred and sixty-five — Oneida County sent one in two thou- 
sand seven hundred and seventy-two of their number to the hospital. 
The Second District sent one in five thousand eight hundred and twenty 
of their number to the hospital; the Third District sent one in seven 
thousand three hundred and fifty-one of their number to the hospital; 
the Fourth District sent one in eleven thousand five hundred and thirty- 
five of their number to the hsopital. 

POPULATION AND PATIENTS OP DISTRICTS. 



SUMMARY. 



Districts. 



I. 



Sum of the annual population for twenty- 
three years 

Patients sent to the hospital in twenty-three 
years 

Average annual population 

Average patients sent to the hospital 

Population to one patient sent to the hos- 
pital in each year 



2,292,643 

827 

99,680 

36 

2,772 



II. 



10,528,406 

1,809 

457,756 

78 

5,820 



ill. 



16,337,520 

2,222 

710,327 

96 

7,351 



IV. 



28,146,477 

2,440 

1,223,760 

106 

11,535 



" This shows a great disproportion in the uses made of the hospital by 
the people of the near and of the remote counties. 

" Taking a basis of one thousand for the extent of the enjoyment of 
the hospital by the remotest districts, the proportionate enjoyment of the 
districts will be: Fourth, one thousand; Third, one thousand five hundred 
and sixty-eight; Second, one thousand nine hundred and eighty-one; 
First, four thousand one hundred and ninety-six. 

" The advantages of the hospital enjoyed by Oneida County have been 
more than double those enjoyed by the counties next beyond, but within 
sixty miles; they are nearly threefold those enjoyed by the counties 
which are from sixty to one hundred and twenty miles distant; and more 
than four times as great as those enjoyed by the people of the counties 
which are more than one hundred and twenty miles distant. 

" It will not be supposed that the insane persons who needed the hos- 
pital care or treatment in these districts were in these proportions. It 
cannot be supposed that the number of lunatics in Oneida County is 
twice is great as that in Oswego; Fulton, Schoharie, Herkimer, and the 
counties beyond Oneida, but within sixty miles; or four times as great 
as that in counties one hundred and twenty and more miles from this 
district. 

"The State censuses of eighteen hundred and fifty -five and eighteen 



Ill 

hundred and sixty-five show the number of the insane in the several 
counties of New York. Arranging these in the districts herein described, 
according to their distance from Utica, they were in proportion to the 
population: 

POPULATION TO ONE LUNATIC IN NEW YORK. 



DISTRICT. 




1865. 



First.., 
Second 
Third.. 
Fourth 



1,300 
1,611 
1,396 
1,904 



" This diversity of advantage of an insane hospital enjoyed by the people 
of near and remote districts is not an accident, nor a peculiaritj^ of New 
York alone. It is a general and probably universal principle — a natural 
and necessary law of nature or humanity; for in all other States whose 
hospital records of patients' residence have been obtained, the same law 
is found to be in operation, and the people send their patients to these 
institutions in proportion to their nearness. 

" In twenty-six States, for various periods of years, insane hospitals have 
been in operation, whose doors are and have been open alike to all of their 
people. The reports of most of these institutions state the number which 
have been sent to them from each county. From the others, copies of 
the records of facts have been obtained, showing the number which 
the various parts of the States have contributed to fill the wards of these 
institutions. In order to determine the extent and application of the 
law of distance in the use of hospitals, these other States and two of the 
British Provinces have been examined and analyzed in the same way as 
New York. 

" They have been divided into concentric districts, making the county 
in which the hospital is situated the first, and the contiguous counties 
the second district, and the others more distant. The populations of 
these several districts have been calculated and determined for each of 
the years in which the hospital has been in operation, or in which the 
records of the residence of the patients were kept and have been ob- 
tained, and the comparison made of the proportion of patients to popu- 
lation of the several districts. 

"It should be here stated that, in making these concentric circular 
divisions, it has been impossible to make them perfectly regular, with 
an exactly equal radius from the common centre, or equal distance of 
the inner and outer boundary from the hospital, for the counties are very 
diversely and irregularly shaped, some of them, as in Maine, being nearly 
one hundred and fifty miles long. While, then, a district may be stated 
to be within certain specified distances from the hospital, circles drawn 
upon the radii would, on both sides, exclude some part of the territory 
that belongs to it, and include some that belongs to its neighbor. Never- 
theless, these irregularities of border or exceptions to the rule will not 
militate with the general plan nor vitiate any calculations made upon or 
deductions made from this analysis of the States and hospital receptions. 

" Twenty-two States and two British Provinces furnish the conditions 



112 

requisite for the purpose of this report, and are included in the calcula- 
tions and statements. 

POPULATION TO ONE PATIENT ANNUALLY SENT TO LUNATIC HOSPITALS. 



STATES. 



Number 
of 

Years. 



Districts. 



I. 



II. 



in. 



IV. 



V. 



Maine 

New Hampshire .... 

Massachusetts 

Rhode Island 

New York 

New Jersey 

Pennsylvania 

East Pennsylvania . 
"West Pennsylvania 

Maryland 

Virginia 

North Carolina 

Mississippi 

Louisiana 

Tennessee 

Kentucky 

Ohio 

Illinois ..... 

Michigan 

Missouri 

Canada 

Nova Scotia 



1840-65 
1842-65 
1833-53 
1849-65 
1843-65 
1848-66 
1850-57 
1857-66 
1857-66 
1850-64 
1828-59 
1856-60 

1858 

1848-58 
1852-59 

11824-55 
1838-66 
1847-64 
1859-65 

|1851-64 
1853-66 
1858-64 



2,835 
2,440 
2,229 
3,094 
2,772 
2,253 
6,061 
5,884 
3,650 
7,034 
5,472 
4,875 
f 15,0l8 
6,653 
3,923 
3,198 
5,060 
3,306 
3,162 
5,910 
3,184 
467 



5,171 

3,470 

3,872 

5,279 

5,820 

3,714 

10,793 

10,497 

10,585 

10,122 

10,314 

6,433 

7,026 

15,235 

8,318 

10,670 

7,304 

7,865 

9,229 

12,553 

7,227 

1,023 



5,630 
6,280 
4,953 



7,351 

5,905 

17,686 

17,414 

22,382 

23,009 

21,570 

9,707 

13,290 

16,645 

13,164 

12,964 

11,712 

9,317 

11,089 

13,989 

7,744 

1,768 



7,890 



11,535 



23,748 
53,629 



24,433 
10,982 
16,151 
21,399 
20,440 
24,132 
28,873 
11,753 
14,208 
15,983 
12,608 
3,057 



25,105 
45,779 
21,276 
25,822 
: 15,826 
27,801 



15,585 
58,039 
26,933 
14,582 



" In all these States the privileges of the hospitals are offered equally 
to the people of the counties. The patients of Oneida and Allegany 
Counties in New York, of Mercer and Warren Counties in New Jersey, 
of Dauphin and Yenango Counties in Pennsylvania, can enter on the 
same terms, enjoy the same advantages, and for the same price. The 
only difference is the burden of cost, care, and labor of travel from 
their homes to the place of healing. And yet the actual use of the hos- 
pital by and the practical value of these institutions to the people of the 
remote districts have been only one fourth as great in New York, about 
one third as great in New Jersey, and less than one third as great in 
Pennsylvania as they have been in the districts near to them. 

" Similar discrepancies in favor of the central counties and against the 
district counties are seen to have existed in all the other States whose 
record has been obtained. 

EFFECT OF MULTIPLYING HOSPITALS. 

"This principle has been remarkably manifested whenever and wher- 
ever a second hospital has been opened in any State and placed in a 
district remote from the one previously in operation. The people who 



* There is apparently something unexplained in the record of one county in each of these 
districts. 



f Excluding 1844, 1845, 1846, and 1847. 
t Excluding 1861, 1862, and 1863. 



113 

sent a few patients to the distant institution now sent many to the hos- 
pital which was brought to their neighborhood. The number of luna- 
tics that found a place of healing was suddenly and permanently 
increased. 

■" In Massachusetts, the hospital at "Worcester was the only State insti- 
tution for the insane in the Commonwealth from eighteen hundred and 
thirty -three to eighteen hundred and fifty-four, when the second hospital 
was opened in Taunton, Bristol County, for the southeastern part of the 
State. The Worcester establishment continued to receive ail the patients 
from the northern, central, and western counties until eighteen hundred 
and fifty-eight, when the third hospital was opened at Northampton, 
Hampshire County, for the western district. In both of these districts 
there was a sudden and large increase of the insane whose friends sought 
and use^ these new places of healing for them. During the eight years — 
eighteen hundred and forty-five to eighteen hundred and fifty-three — 
previous to the opening of the Taunton Hospital the people of Bristol 
County had sent one hundred and fifty-one patients to Worcester, which 
was an annual average of one patient in four thousand four hundred and 
thirty-four inhabitants. During the eight years after the hospital was 
opened within their borders they sent three hundred and twenty -four 
patients to it, which was an annual average of one patient in two thou- 
sand one hundred and ninety-four people. 

" In the former period the people of Plymouth County sent one in three 
thousand seven hundred and nineteen of their number, and in the latter 
period one in two thousand seven hundred and seventy-four. 

" Barnstable, Dukes, and Nantucket Counties sent in the former period 
one in four thousand one hundred and eighteen, and in the latter one in 
three thousand five hundred and seventy-three to the hospitals. 

POPULATION FOR ONE PATIENT SENT ANNUALLY TO THE STATE HOSPITALS. 



COUNTIES. 



1845 to 1853. 



p 



m 

g.3 

o o 

f V 

• o 
: >a 

: C 



hj 



CD CD 

C 
CD 



1854 to 1862. 



p 



m 

_ c 
£3 
o o 

o 

Pi 



^ 



•a 



CD CD 

: o 

: 3 

• CD 



w 



o 



Bristol 

Plymouth ... 
Barnstable ] 
Nantucket > 
Dukes J 

Totals... 



151 
132 

104 



669,581 
493,215 

429,319 



387 



1,592,115 



4,434 
3,719 

4,118 



324 

204 

118 



810,903 
565,981 

421,662 



2,194 

2,774 

3,573 



4,111 



646 



1,798,546 2,784 



102.1 
34. 

15.2 



42.9 



" During the four years — eighteen hundred and fifty-four to eighteen 
hundred and fifty-eight — the people of Hampshire County sent thirty- 
seven patients to the Worcester Hospital, which was an annual average of 
one in four thousand and eight inhabitants. In the four years after the 
opening of the third hospital in their midst, the same people sent eighty- 



15 



1W 

five persons, or one in one thousand seven hundred and eighty-seven of 
their number to its care. 

" Franklin County sent in the former period nineteen patients, or one in 
six thousand five hundred and seventy-four people, to Worcester; and in 
the latter period fifty-two, or one in two thousand four hundred and 
nineteen people, to Northampton. Berkshire County is geographically 
fifty miles nearer to Northampton than to Worcester. But a range of 
mountains lies between, and the roads are difficult for travelers, who can 
use only private conveyances, except the Western Eailroad to Spring- 
field, and the Connecticut River Eailroad from Springfield to North- 
ampton. This practically reduces the difference of distance between 
the two hospitals to thirty miles. And many when once in the cars on 
the Western Eoad find it easier to continue fifty-four miles further to 
Worcester, than to change cars and go twenty miles to Northampton, 
with their patients. Therefore the increase is less in BerkshireMJounty 
than in the others. Nevertheless, there was an increase. 

" Before eighteen hundred and fifty-eight the Berkshire people sent 
thirty -three patients, or one in six thousand nine hundred and thirty- 
seven people, yearly to Worcester, and after that they sent to Worcester 
and Northampton forty-seven patients, or an average in each year of one 
in four thousand seven hundred and fifteen people. 

11 To the towns in the eastern part of Hampden County, Worcester is 
nearer and more accessible than Northampton. Most of tke people 
must necessarily use the Western Eailroad, whether going to Worcester 
or Northampton, and all must change cars at Springfield if they go to 
Northampton, but not if they go to Worcester. 

" The people of Hampden County sent in the former period one in two 
thousand one hundred and eighty-five of the living to Worcester, and in 
the latter, one in one thousand nine hundred and eighty-eight in each 
vear. 

POPULATION TO ONE PATIENT SENT TO HOSPITAL BEFORE AND AFTER 
NORTHAMPTON HOSPITAL WAS OPENED. 

Western District. 



COUNTIES. 



1855 to 1858, four years. 



1859 to 1862, four years. 




Increase. 





hj 


w 




V g 


SB 

5" 


o g 


V, o 


g-IL 


P 

trt- 


P o 


&.1L 


a> cd 




S-* 8 


a> ca 


P «*• 


CO 


S-.B 


P rt- 




CD 

a 


? p 








• 




6,437 


47 


221,640 


4,715 


6,574 


52' 


125,830 


2,419 


4,008 


85 


151,897 


1,787 


2,185 
3,717 


116 


230,784 


1,988 


300 


730,151 


2,433 



sr.i-tf 

2 <* 
p <-t 

» 2 

p "* 



Berkshire ! 33 

Franklin ! 19 

Hampshire ! 37 

Hampden 101 



Total Counties 190 



212,437 
124,916 
148,294 
220,680 



706,327 



38.6 

171.2 

124.3 

9.9 



52.7 



" The people of Hampshire County nearly trebled the number and 
proportion of their patients in the hospital. The people of Franklin and 
Bristol more than doubled them, and the other counties also increased 



115 

them very greatly, and thus so many more of their lunatics found places 
of healing and protection when the hospital was brought to their neigh- 
borhood and within their reach. 

EFFECT OF RAILROADS AND OTHER FACILITIES OF TRAVEL. 

" Facilities of travel, navigable rivers, canals, railroads, public high- 
ways, public conveyances, which render communication easy and cheap, 
and intercourse familiar, and virtually diminish distance from the hospital, 
increase the ratio of patients that are sent to it. We therefore find that 
three counties which are situated along the course of rivers, canals, 
roads, etc., leading directly to the situation of the hospitals, have sent 
more patients to these institutions than other counties of equal popula- 
tion and at equal distances, but not favored with these facilities of com- 
munication. Ten counties in New York along the line of tbe railroad, 
canal, etc., east and west of Utica, with easy means of travel, sent two 
thousand one hundred and fifty-one patients to Utica, or one in seven 
thousand two hundred and sixty-six. While during the same period ten 
other counties, northeast and southwest from Utica, with no easy means 
of communication, sent six hundred and forty-seven patients, or one in 
eleven thousand nine hundred and thirty-four of their number to the 
State Hospital. Taking all these facts into view, we have here indis- 
putable proof of the effect of distance in diminishing the practical bene- 
fits of lunatic hospitals to the people of any district. In all these States 
these hospitals are as open and their advantages as freely granted to 
the patients from the most remote towns as to those in their very neigh- 
borhood. It is not hinted, or even suspected, that the lunatics whose 
friends reside afar off are not as kindly, as faithfully, and as success- 
fully treated, and at as small a cost, as those whose friends are so near 
as to keep a watchful vigilance over their welfare. 

HOSPITALS ARE BETTER KNOWN TO THE NEIGHBORING PEOPLE. 

" The idea of the hospital purposes and its management is familiar to 
those who live in its vicinity. They know its means, its objects, and 
its administration; they know the character of its officers and its 
attendants. They are frequently witnessing its operations and results 
in the many who are going to and returning from it in improved or 
restored mental health. Whenever they think of the possibility of their 
becoming insane, the idea of the hospital presents itself to their minds in 
the same connection almost as readily as the idea of their own chambers, 
their own physician, and the tender nursing of their own family is asso- 
ciated with the thought of having a fever or dysentery; and when any 
one of their family or friends become deranged the hospital occurs to 
them as a means of relief, and they look uj)on it as a resting place from 
their troubles. 

" But this ready association of the hospital with lunacy and this 
generous confidence in its management diminishes as we recede from it. 
The people in the remoter places know the general facts; but distance 
lends an obscurity to the notion, and thus the character of the hospital 
and its administration do not stand before them as the thought of home 
and domestic arrangements, of which they can cheerfully and trustfully 
avail themselves in any emergency. To them the hospital seems a 
strange place; perhaps a place of unkind restraint, or even of needless 
confinement, rather than a home of tenderness. Its officers are to them 



116 

strangers rather than friends; and its attendants, though good and 
honest persons, are not as household comforters and nurses, or even as 
neighbors, whose ready and affectionate sympathy is sure, and on whom 
they are accustomed to call in time of trouble, and to whom they 
unhesitatingly commit the care of their disordered and distressed 
relatives or children. 

" Then the unwillingness to be far separated from their suffering or 
weakened friends operates with many. This is, indeed, a mere feeling 
or sentiment; but it is converted into practical facts, and retains some 
at home who would otherwise be sent to and cured in a hospital if it 
were nearer to them. The State Lunatic Hospital, when it is used, is no 
better to the people of Oneida than to those of Cattaraugus and Clinton; 
but so long as a portion of the people of the remote counties do not feel 
so their insane friends are not sent there. 

" The difficulties and expense of sending lunatics over long distances, 
or unfrequented and indirect roads, or by private conveyances, are per- 
haps the most, effectual obstacle in the way, and more than any other 
diminish the number of patients with the increase of miles that separate 
them from the hospital. 

" For these reasons the towns in the neighborhood of the public hos- 
pital in this State have enjoyed more than four times as much of its 
benefits as the remote towns; and all the other hospitals mentioned in 
this article have been conrpelled to confer their blessings in a similar 
and some of them in a much greater disproportion upon the people of 
the neighboring than upon those of the distant districts of the State to 
which they respectively belong. 

" We think we have here presented facts enough to establish it as a 
general principle that the advantages of any public lunatic hospital, 
however freely and equally they may be offered to all the people of any 
State, are yet to a certain degree local in their operation, and are enjoyed 
by people and communities to an extent in proportion to their nearness 
to or distance from it. 

" Whenever and wherever the same causes exist the same effects must 
be produced, and any hospital that may be hereafter established must 
be subject to the same law. This law of nearness, inviting and increas- 
ing the patients, and of distance, preventing and diminishing the number 
in hospital, is our very nature, and must operate in the future as well as 
the past. The people will be influenced by the same motives in time to 
come, as they have been in the years that have gone by." 

OBSERVATIONS ON FOREGOING TOPICS. 

Thus we are shown, by the interesting paper prepared with the great- 
est care by this able and accurate observer, that insane asylums dispense 
their blessings almost in proportion to their convenience to the people. 
We also learn from other sources that the proportion of cures from the 
nearer counties is much greater than those in the second radius of dis- 
tance, and so on with corresponding ratio to the third and fourth. This 
is what we might naturally expect, as those who live near the hospital 
would be sent to it for treatment at the earliest period after the attack, 
while those living at the greatest distance would defer the separation 
from the afflicted member of the family to the latest moment, and too 
often till all hope of relief has passed away. 

It is interesting to notice in this connection that since the publication 
of Doctor Jarvis' paper the State of New York has inaugurated an 



117 

entirely new policy, and we are informed by Doctor Charles S. Hoyt, 
Secretary of the Board of State Commissioners of Public Charities, in a 
letter recently received from that gentleman, that it has been determined 
to bring every insane person within its borders under the supervision of 
its officers; and that bills have already been passed authorizing the 
establishment of first class asylums for the accommodation, care, and 
treatment of all the insane in the State. 

The following brief description of these asylums, with amount of 
appropriation for each, as well as their location, will best convey an 
idea of the noble work that has been undertaken, and may serve to 
guide us in the judicious location of our new asylum: 

THE NEW YORK STATE LUNATIC ASYLUM, AT UTICA. 

This asylum, the only State institution for the insane fully completed, 
was organized by the Legislature in eighteen hundred and forty-two, 
and opened for patients in eighteen hundred and forty-three. 

The buildings consist of a central edifice, two front and two rear 
wings, a cross wing, additional wings, and outbuildings. The front and 
centre are constructed of stone, and the other portions mainly of brick. 
The central building is four stories in height above the basement, and 
one hundred and twenty by seventy-six feet on the ground. The front 
wings are three stories high, and each has an area of two hundred and 
fifteen by thirty-five feet. The rear wings are of the same height, two 
hundred and fifty feet each in length, and thirty feet in width. The 
cross wing is two stories high, twenty-five feet wide, and three hundred 
and fifty feet long. One of the additional wings is two, and the others 
%are one story in height. The former has an area of eighty-five by 
twenty-five feet, and the latter one hundred and sixty-three by thirty- 
four feet. The entire edifice presents a front of five hundred and fifty, 
and the flanks a depth of two hundred and fifty feet. It is heated by 
steam, lighted by gas, and ventilated in the most approved manner. 
The outbuildings are a mortuary, bakery, coal house, work skoj)S, boiler 
and engine house, containing also the fans for ventilation, and drying 
and ironing rooms, wash house, farm buildings, carriage house, barns, 
ice house, etc. 

The asylum, as first erected, and until eighteen hundred and fifty-two, 
had room for only four hundred and fifty (450) patients. Since that 
date, the original buildings have been remodeled, the additional wings 
erected, and the cross wing adapted to the insane, by which the institu- 
tion has been made to accommodate six hundred (600) patients. It 
also furnishes apartments for the resident officers and necessary attend- 
ants and employes. Cost — six hundred and sixty-one thousand and 
sixty -five dollars and fifty-eight cents. 

THE WILLARD ASYLUM FOR THE INSANE, AT OVTD. 

V 

This institution, designed for the chronic pauper insane, heretofore 
provided for in the county poorhouses, and for those who may be here- 
after discharged from the State Asylum at Utica as incurable, was 
established by an Act of the Legislature, passed April fifth, eighteen 
hundred and sixty-five. The site, known as the " State Agricultural 
Farm," contains four hundred and seventy-five (475) acres, near the 
Tillage of Ovid, on the east shore of Seneca Lake. The erection of the 
building was commenced in the Spring of eighteen hundred and sixty- 



118 

six, and it was so far advanced as to be opened for patients in October, 
eighteen hundred and sixty-nine. 

The main asylum building is situated near the lake. The plan of this 
edifice comprises a central building for the Superintendant's residence 
and offices, and a north and a south wing, with extensions from the 
extremities of these to the rear, for patients. It is a plain, substantial, 
three story brick structure, well planned and arranged, and furnished 
with the appliances and conveniences requisite for its purposes. 

In addition to the main asylum, there is the "Agricultural College 
Building," on the premises when acquired by the State, and, now known 
as the " Branch." This building, situated about one mile from the main 
edifice, was remodeled and fitted up the past year, and occupied by 
female patients in November »ast. It is a plain, substantial brick struc- 
ture, in good preservation, and appears to be well adapted for the pur- 
poses to which it is applied. The Trustees estimate it to have cost one 
hundred and fifty thousand dollars. 

The cost of the buildings now in use for the insane, and the Trustees' 
estimated cost for the completion of those in process of erection and 
proposed, is shown by the following statement: 



Cost of the main asylum and branch in use, including fur- 
niture, out buildings, etc. (as stated above) 

For the completion of the south wing, including the amount 
already expended (estimated) 

For the extension to the north wing, erecting a single group 
of detached buildings, furniture, fences, further water sup- 
ply, etc. (estimated) 

Total 



$446,998 44 

81,728 67 



200,000 00 



$728,727 11 



The completion of the buildings as proposed will give accommodations 
for the insane as follows: in the main asylum, five hundred (500); the 
" branch," two hundred (200); single group of cottages, two hundred 
(200); total, nine hundred (900) patients. 

The Trustees of this asylum express the opinion that its capacity 
may be very properly extended by the erection of additional groups of 
detached buildings similar to the one proposed at different points on the 
farm, so as to include nearly if not all the chronic pauper insane of the 
State not suitably provided for otherwise. In the judgment of these 
officers this would prove economical, by lessening the c£>st of the build- 
ings per capita, and utilizing the labor of the insane, and at the same 
time secure to them under a single responsible direction and control, 
better treatment and care. This subject is one of such great public 
importance, not only as affecting the insane, but as to the cost of pro- 
viding for their maintenance, that the Board deems it proper to present 
it to the attention of the Legislature. 

THE HUDSON RIVER STATE HOSPITAL FOR THE INSANE 

Was established by the Legislature March sixteenth, eighteen hundred 
and sixty-seven. The site, previously selected by Commissioners ap- 
pointed by the Governor, contains three hundred (300) acres. Its loca- 



119 

tion is on the east bank of the Hudson Kiver, two miles north of the 
City of Poughkeepsie. 

The plan of this hospital comprises a central edifice for administrative 
purposes, and a north and a south wing, composed of four sections each, 
for patients. It also includes a chapel, general kitchen, boiler and engine 
house, workshops, gas house, etc., to be situated at the rear of the cen- 
tral structure. 

The erection of the building was commenced in September, eighteen 
hundred and sixty-seven. The three extreme sections of the south wing 
are nearly finished and partly furnished, and it is stated, if funds were 
provided, could be soon ready for patients. The boiler and engine house 
are built and two boilers set; the foundations for the four remaining 
boilers required for the entire building are laid; the great chimney, con- 
taining flues for the boilers, kitchen range, bake shop, gas retorts, and 
central ventilating shaft, is also built; the underground air duct is made, 
and the main sewer laid from the chimney to the river. The reser- 
voir for the full capacity of the hospital is two thirds completed, and 
the arrangements for water are said to be adequate for its present 
purposes. 

The hospital is being constructed of North Eiver brick, with a better 
quality for face work. The window heads are of Ohio stone, with blue 
stone introduced to increase the artistic effect. The centre building and 
a part of two sections of each wing will be three, and the residue two 
stories in height. 

The portions of the building erected will accommodate one hundred 
and twenty (120) patients, and when the hospital is completed according 
to the plans adopted it will furnish room for four hundred (400). 

The Medical Superintendent reports that the estimated cost of the 
building when the plans were adopted was six hundred and sixty-six 
thousand dollars; but in the event of the continuance of the inflated 
prices for materials and labor heretofore paid it will cost, when com- 
pleted according to these plans, twelve hundred thousand dollars. It is 
stated, however, by this officer, that this estimate may be modified by 
the gradual decrease in prices now taking place, and the advantages to 
be derived from the increase of power from the boilers, in the use of the 
machinery, etc., but that no great reduction can be anticipated. The 
institution is designed for the treatment of cases of acute insanity, and 
the building is being constructed with the adaptations and appointments 
necessary to carry out its objects. 

THE BUFFALO STATE ASYLUM FOR THE INSANE 

Was organized under chapter three hundred and seventy-eight, laws 
of eighteen hundred and seventy. The site, previously selected by desig- 
nated Commissioners, consists of two hundred (200) acres, situated near 
Buffalo, and was presented by that city to the State. 

The Managers report that the ground plan of the building has been 
adopted, and that the plan of the elevation will probably be soon ap- 
proved, and the work of erection commenced. 

The Board had expected information as to the estimated cost of the 
building from the Managers, but it has not been received. We learn that 
it is to be constructed of brick, with arrangements for the treatment of 
cases of acute insanity, and with capacity for the accommodation of five 
hundred (500) patients. The general estimate of superintendents of in- 
sane asylums for the erection of plain, substantial buildings of such 



120 

character, and appropriately furnishing the same, at the present prices 
for material and labor, is one thousand six hundred dollars per inmate. 
On this estimate it will cost, when completed, eight hundred thousand 
dollars. 

• The following statement shows the capacity and cost of the State 
Asylums for the insane in use, and the estimated capacity and cost of 
those in process of erection, or for which appropriations have been made, 
when completed according to the several plans adopted, as. hereinbefore 
referred to : 



NAMES OF ASYLUMS. 




Cost of the 
buildings. 



The New York State Lunatic Asylum at Utica. 
The Willard Asylum for the Insane at Ovid.... 
The Hudson Elver State Hospital for the 

Insane at Poughkeepsie 

The Buffalo State Asylum for the Insane at 

Buffalo 

The New York State Homoeopathic Asylum for 

the Insane at Middleton 

Total 



$661,065 58 
728,727 11 

1,200,000 00 

800,000 00 

360,000 00 

$3,749,792 69 



In conclusion, the Board deems it proper to submit a general view of 
the present number of the insane in custody, of their condition in res- 
pect to recovery, of the present provision made for them, and the 
requirements for the future. 

It will be observed that there were at the close of the first year, four 
thousand four hundred and eighty-four (4,484) insane persons in public 
institutions. Of these, nine hundred and twenty-five (925) were in the 
State Asylums, and one hundred and forty-eight (148) in incorporated 
institutions receiving State aid. The Counties of New York and Kings 
contained one thousand nine hundred and sixty-seven (1,967); and there 
were in the County Poorhouses and City and County Asylums one 
thousand four hundred and forty-four (1,444). Thus we see that the 
State of New York has not only determined to provide asylums for the 
reception of all of her insane population, but has wisely chosen locations 
in different portions of the State, that they may be easily accessible to 
all of her citizens who may be so unfortunate as to require their healing 
influences; though while we commend the generous liberality and muni- 
ficent appropriations that distinguish this noble act of humanity, we 
cannot advise our legislators to follow her example in all respects. In 
the enlightened policy of providing suitable hospitals for all who require 
their use, we most heartily and unequivocally concur; but we cannot 
see the necessity of such lavish expenditure in building palacial resi- 
dences for a class of persons who can neither appreciate the magnifi- 
cence of the edifice, nor pay for the luxury. The Poughkeepsie Asylum, 
it appears, will cost three thousand dollars for each patient to be accom- 
modated; which, according to our view, is at least twice as much as any 
State institution should cost under any circumstances; and for buildings 
alone, we are satisfied that one thousand dollars ($1,000) per patient is 



121 

enough. It is true that all asylums of this class should present an 
attractive and cheerful appearance, its architectural proportions should 
be in good taste, plain, neat, and substantial; but all expenditures simply 
for ornamentation should be scrupulously avoided, otherwise charity 
may be crippled at the expense of pride and vanity. 

But this is a digression from the subject under discussion. "We have 
desired to show, and trust we have succeeded, that asylums are intended 
for the use of the people, and to be most useful they must be accessible. 
This being admitted, it will be easy to conclude that our next hospital 
for the insane should be located somewhere on or near the Bay of San 
Francisco, and within easy reach of that city. At what particular lo- 
cality, must necessarily depend on many important circumstances and 
indispensable conditions; and that the commission to which this respon- 
sible duty should be confided may not, from inadvertance, overlook or 
neglect any of them, we append the following suggestions from the As- 
sociation of Medical Superintendents of American Institutions for the 
Insane, and of the English and Scotch Boards of Commissioners in Lu- 
nacy, who, from their great ability and long experience, would not be 
likely to make unnecessary recommendations on the one hand nor over- 
look important matters on the other. 

PROPOSITIONS RELATIVE TO THE STRUCTURE AND ARRANGEMENT OF AMERI- 
CAN INSTITUTIONS FOR THE INSANE, 1853. 

I. Every hospital for the insane should be in the country, not within 
less than two miles of a large town, and easily accessible at all seasons. 

II. No hospital for the insane, however limited its capacity, should 
have less than fifty acres of land devoted to gardens and pleasure grounds 
for its patients. At least one hundred acres should be possessed^pby every 
State hospital or other institution for two hundred patients — to which 
number these propositions apply, unless otherwise mentioned. 

III. Means should be provided to raise ten thousand gallons of water, 
daily, to reservoirs that will supply the highest parts of the building. 

IV. ]N~o hospital for the insane should be built without the plan having 
been first submitted to some physician or physicians who have had the 
charge of a similar establishment, or are practically acquainted with all 
the details of their arrangements, and received his or their full appro- 
bation. 

V. The highest number that can with propriety be treated in one 
building is two hundred and fifty, while two hundred is a j)referable 
maximum. 

YI. All such buildings should be constructed of stone or brick, have 
slate or metallic roofs, and, as far as possible, be made secure from acci- 
dents by fire. 

VII. Every hospital having provision for two hundred or more 
patients should have in it at least eight distinct wards for each sex — 
making sixteen classes in the entire establishment. 

VIII. Each ward should have in it a parlor, a corridor, single lodgirig 
rooms for patients, an associated dormitory, communicating with a 
chamber for two attendants, a clothes room, a bath room, a water closet, 
a dining room, a dumb waiter, and a speaking tube leading to the kitchen 
or other central part of the building. 

IX. JSTo apartments should be provided for the confinement of patients, 
or as their lodging rooms, that are not entirely above ground. 

16 



122 

X. No class of rooms should ever be constructed without some kind 
of window in each, communicating directly with the external atmosphere. 

XL .No chamber for the use of a single -patient should ever be less 
than eight by ten feet, nor should the ceiling of any story occupied by 
patients be less than twelve feet in height. 

XII. The floors of patients' apartments should always be of wood. 

XIII. The stairways should always be of iron, stone, or ©ther inde- 
structible material, ample in size and number, and easy of ascent, to 
afford convenient egress in case of accident from fire. 

XIV. A large hospital should consist of a main central building with 
wings. 

XV. The main central building should contain the offices, receiving 
rooms for company, and apartments entirely private for the Superin- 
tending Physician and his family, in case that officer resides in the 
hospital building. 

XYL The wings should be so arranged that if rooms are placed at 
both sides of a corridor the corridors should be furnisked at both ends 
with movable glazed sashes for the free admission of both light and air. 

XVII. The lighting should be by gas, on account of its convenience, 
cleanliness, safety, and economy. 

XVIII. The apartments for washing clothing, etc., should be detached 
from the hospital building. 

XIX. The drainage should be underground, and all the inlets to the 
sewers should be properly secured to prevent offensive emanations. 

XX. All hospitals should be warmed by passing an abundance of pure 
fresh air from the external atmosphere over pipes or plates, containing 
steam under low pressure, or hot water, the temperature of which at 
the boiler does not exceed two hundred and twelve degrees Fahrenheit, 
and placed in the basement or cellar of the building to be heated. 

XXL A complete system of forced ventilation in connection with the 
heating is indispensable to give purity to the air of a hospital for the 
insane, and no expense that is required to effect this object thoroughly 
can be deemed either misplaced or injudicious. 

XXII. The boilers for generating steam for warming the building 
should be in a detached structure, connected with which may be the 
engine for pumping water, driving the washing apparatus, and other 
machinery. 

XXIII. All water closets should, as far as possible, be made of inde- 
structible materials, be simple in their arrangement, and have a strong 
downward ventilation connected with them. 

XXIV. The floors of bath rooms, water closets, and basement stories 
should, as far as possible, be made of materials that will not absorb 
moisture. 

XXV. The wards for the most excited class should be constructed 
with rooms on but one side of a corridor, not less than ten feet wide, the 
external windows of which should be large, and have pleasant views 
from them. 

XXVI. Whenever practicable, the pleasure grounds of a hospital for 
the insane should be surrounded by a substantial wall, so placed as not 
to be unpleasantly visible from the building. 

Additional Declarations, 1866. 

The following comprehensive resolutions were proposed by Dr. 
Nichols, of the Government Hospital for the Insane at Washington, and 



123 

adopted by the Convention of Medical Superintendents of American 
Institutions for the Insane, in eighteen hundred and sixty-six, and em- 
phatically reaffirmed in eighteen hundred and sixty-seven. They com- 
prise a full and clear declaration of sound principles, tested by expe- 
rience: 

1. The large States should be divided into geographical districts of 
such size that a hospital, situated at or near the centre of each district, 
will be practically accessible to all the people living within its boun- 
daries, and available for their benefit in case of mental disorder. 

2. All State, county, and city hospitals for the insane should receive 
all persons belonging to the vicinage designed to be accommodated by 
each hospital, who are affected with insanity proper, whatever may be 
the form or nature of the bodily disease accompanying the mental 
disorder. 

3. All hospitals for the insane should be constructed, organized, and 
managed substantially in accordance with the propositions adopted by 
the association in eighteen hundred and fifty-one and eighteen hundred 
and fifty -two, and still in force. 

4. The facilities of classification or ward separation possessed by each 
institution should equal the requirements of the different conditions of 
the several classes received by such institution, whether these different 
conditions are mental or physical in their character. 

5. The enlargement of a city, county, or State institution for the 
insane, which, in the extent and character of the district in which it is 
situated, m conveniently accessible to all the people of such district, may 
properly oe carried, as required, to the extent of accommodating six 
hundred patients, embracing the usual proportions of curable and incur- 
able insane in a particular community. 

Resolutions offered in the same Association in 1870. 

Resolved, That this Association reaffirm in the most emphatic manner 
its former declarations in regard to the construction and organization of 
hospitals for the insane; and it would take the present occasion to add 
that at no time since these declarations were originally made has any- 
thing been said or done to change in any respect its frequently expressed 
and unequivocal convictions on the following points, derived as they 
have been, from the patient, varied, and long continued observations of 
most of its members: 

First — That a very large majority of those suffering from mental dis- 
ease can nowhere else be as well or as successfully cared for for the 
cure of their maladies, or be made so comfortable, if not curable, with 
equal protection to the patients and the community, as in well arranged 
hospitals specially provided for the treatment of the insane. 

Second — That neither humanity, economy, or expediency can make it 
desirable that the care of the recent and chronic insane should be in 
separate institutions. 

Third — That these institutions, especially if provided at the public 
cost, should always be of a plain but substantial character; and, while 
characterized by good taste and furnished with everything essential to 
comfort, health, and successful treatment of the patients, should avoid 
all extravagant embellishments and every unnecessary expenditure. 

Fourth — That no expense that is required to provide just as many 
of these hospitals as may be necessary to give the most enlightened 



124 

care to their insane can properly be regarded as either unwise, inexpe- 
dient, or beyond the means of any one of the United States. 

These resolutions came before the Association in eighteen hundred 
and seventy-one, and were "Unanimously adopted, the following Superin- 
tendents voting upon the question: • 

Yeas — Doctors Ray, Butler, Kirkbride, McDill, Shew, Walker, Hughes, 
Parsons, Landor, Reidle, Compton, Gundry, Clopton, Grissom, Lewis, 
Bancroft, Curwen, Evarts, Dickson, Roy, Gray, and Read. • 

Nays — None. 

In the discussion upon their adoption, Doctor Ray used this language: 

"Mr. President: I feel very much as Mr. "Webster did on one occasion 
when called upon, as he said, to reaffirm an ordinance of nature. The 
opinions of the Association on certain points have been so well fixed for 
many years that I supposed they would never be altered; that they 
were correct from the very nature of things. I am not clear now about 
the necessity of bringing up again the subject matter of these resolu- 
tions. It does seem to me like reaffirming the laws of nature. The 
questions implied in these resolutions you are aware have come up at 
various times before the Association, and have been very thoroughly dis- 
cussed. It seems to me we have discussed them until they are thread- 
bare. For this reason I do not feel like speaking upon them ai^present." 

In reply to a question asked by Doctor Cook, Doctor Kirkbride made 
these remarks: 

" Speaking for myself, I should say, without any hesitation whatever, 
that I do mean, as the fourth resolution declares, that every State should 
provide enough institutions to accommodate all the insane within its 
borders. It is my firm conviction that the poorest State in this country 
is perfectly able to provide just as many hospitals as are necessary. I 
do not believe any Government has the right to say to one family, ' We 
will take care of your afflicted one,' and say to another, l We will not 
take care of yours,' simply because one is a more recent case than the 
other. If we undertake to provide for a part of the insane, we are 
bound to provide for all. One family has just as good a right to claim 
the bounty of the State as another." 

Doctor Cook — "You would not exclude chronic cases?" 

Doctor Kirkbride — " I certainly would not." 

ENGLISH LUNACY COMMISSIONERS ON SITES, CONSTRUCTION, ETC. 

[Suggestions and Instructions in Reference to (1) Sites, (2) Construction and Arrangement 
of Buildings, (3) Plans of Lunatic Asylums, by the Commissioners in Lunacy for 
England and Wales.] 

JYo. 1 — Sites.- — General. 

1. The site of an asylum should be of a perfectly healthy character, 
and offer facilities for obtaining a -complete system of drainage. A 
chalky, gravelly, or rocky subsoil is most desirable; but if a clayey sub- 
soil only can be obtained, an elevated position is indispensable. 

It should not be near to any nuisances, such as steam engines, shafts 



125 

of mines, noisy trades, or offensive manufactures; neither should it be 
surrounded, or overlooked, or intersected, by public roads or footpaths. 

Proportion of Land. 

2. The land belonging to the asylum should, when practicable, be in 
proportion of not less than one acre to four patients, so as to afford 
ample means for agricultural employment, exercise, and recreation; and 
should be so situated as to offer facilities for any extension which may 
become necessary at a future period. 

Form of Ground. 

3. The site of the building should be elevated, as respects the sur- 
rounding country, and (if to be obtained) undulating in its surface, and 
cheerful in its position, and having a fall to the south. 

Position and Aspect of Budding. 

4. The building should be placed near the northern boundary of the 
land; and it is important that the site should afford a plateau of sufficient 
extent for the structure, and for ready access from the north; the whole 
of the southern portion of the land being available for the undisturbed 
use of the patients. 

Locality. 

5. The asylum should be as central as possible to the mass of po]DU- 
lation in the country or district for which it is to be erected, and should 
be convenient with respect to its easy access by public conveyance in 
order to facilitate the visits of friends and the supply of stores. 

Supply and Quality of Water. 

6. It is of the utmost importance that there should be a constant and 
ample supply of good water, of which a careful analysis should be made 
with a view of determining the proper materials for pipes and reservoirs, 
and also to ascertain, its fitness for the purposes of drinking and wash- 
ing. The quantity, exclusive of rain water, should at the dryest season 
be not less than twenty-five gallons per patient per diem, and the amount 
should be accurately gauged. 

No. 2. — Construction and Arrangement of Buildings. — General Form. 

1. The general form of an asylum should be such as to afford an unin- 
terrupted view of the surrounding country, and the free access of sun 
and air, and be so arranged as to give the principal day rooms on the 
lowest and middle stories a southern or southeastern aspect. 

Entrance and Offices to the North. 

2. There should be no road of approach or public entrance on the 
south side of the asylum. The general entrance, the porter's room, the 
reception and visitors' rooms, the clerk and steward's office, and store- 
rooms, and the other offices, should be placed on the north side of the 
building. 



126 , 

Character of Building. 

3. As the building is intended for the accommodation of pauper 
patients, all superfluous external decoration should be avoided; at the 
same time it should be rendered as cheerful and attractive as due consid- 
eration of economy will permit. 

Separation of Sexes, and Classification. 

4. The accommodation for the male and female patients should be kept 
distinct on either side of the centre, and the building should be so con- 
structed as to admit of the separation of the male and female patients, 
respectively, into three classes. As a general rule the numbers in each 
class should be such as to require the services of not less than two 
attendants. 

Stories. 

5. The building may consist of three stories, provided the uppermost 
story be devoted to sleeping accommodation. 

Buildings for Working Patients. 

■ 

6. Euildings of a cheap and simple character, consisting merely of 
associated day-rooms and dormitories, without long corridors or other 
expensive arrangements, should be provided for the use of working 
patients. These buildings should be placed in connection with the 
washhouse and laundry on the female side, and be conveniently situate 
in reference to the workshops and farm buildings on the male side. 

For Idiotic and Epileptic Patients. 

Provision of an equally simple and inexpensive description should also 
be made for a portion of the idiotic and epileptic patients, and also for 
chronic cases. 

Size of Chapel and Offices. 

7. The chapel and all offices and parts of the building common to the 
establishment — such as the kitchen and scullery, the washhouse and 
laundry, the workshops and storerooms, should be sufficiently spacious 
to meet the prospective wants of the asylum in case of an increase in 
the number of patients. 

Position of Chapel. 

8. The chapel should not be placed over the kitchen. It should be 
capable of comfortably accommodating at least three fourths of the 
patients. It should have the usual character and arrangement of a 
church, and contain no special or peculiar provision for the separation of 
the sexes. 

General Dining Hall. 

9. A general dining hall, conveniently situate with reference to the 
kitchen, and capable of being made available for the purposes of recrea- 
tion, should be provided for the patients of both sexes. 



127 

Officers' 'Residences. 

10. A good residence should be provided for the Medical Superin- 
tendent, with kitchen and other necessary domestic offices. Suitable 
apartments of moderate extent should also be provided for the Assistant 
Medical Officer, the Steward, and the Matron, but for these officers a 
separate kitchen is not required. 

Domestic Servants. 

There should also be sleeping accommodation for the domestic servants 
of the institution, with whom might conveniently be associated those 
patients who habitually work in the kitchen. 

Proportion of Single Booms. 

11. The proportion of single rooms throughout the Asylum need not 
exceed one third. The single rooms should be chiefly in the wards 
appropriated to the excited and the sick. A few should be available for 
special cases in the other wards. 

Arrangement of Upper Stories — Passages and Corridors. 

12. In the upper stories passages of communication of moderate width 
should be' adopted in lieu of wide corridors, and the dormitories should 
be placed to the south. Generally, long, wide, and expensive corridors 
should not be constructed, but only so much passage or corridor pro- 
vided as may be absolutely necessary to connect the several parts of the 



building. 



Stairs. 



13. The stairs should be built of stone, without windows or long, 
straight flights. The well should be built up, and hand rails should be 
provided. 

Staircases. 

14. The staircases should be so arranged that the medical officer, 
attendants, and others may pass through from one part to another with- 
out necessarily retracing their steps. 

Material for Floors — Provision Against Fire. 

15. All the corridors and day and sleeping rooms should have boarded 
floors, and it is desirable that the boards should be tongued. It is indis- 
pensable that they should be of the best wood, and thoroughly well 
seasoned. The floors of the sculleries, lavatories, and water closets 
need not be of wood. There should be a disconnection of the floor and 
joists at all the internal doorways, by means of a stone sill; and in all 
cases where a fireproof construction is not adopted similar separations, 
at not greater distances apart than fifty feet, should be made in the floors 
and joists of the galleries or corridors. Provision should also be made 
for a complete fireproof separation of the timbers of the roof at the 
same distance, and the parapet should be carried through the roof one 
foot above the slating. Oak floors, capable of being cleaned by dry 
rubbing, are preferable for the corridors and day rooms. 



128 

Plastering. 

The walls of the galleries and rooms generally should be plastered. 

Number of Beds in Dormitories. 

16. No associated bedrooms should be designed to contain less than 
three beds. 

Height of Each Story, and Dimensions of Booms. 

17. The general height of each story should not be less than eleven 
feet. The associated dormitories should not contain less than fifty feet 
superficial to each bed or patient. 

Dormitories. 

The separate sleeping rooms generally should be of not less than the 
following dimensions, viz: nine feet by seven superficial, and eleven feet 
high. Those appropriated to sick or bedridden patients should be of 
somewhat larger dimensions, and some of these should be provided with 
a fireplace. 

Size of Day Booms. 

18. The day rooms, of which there should be at least one in each 
ward, should contain not less than twenty feet superficial for each 
patient, and should be calculated for the whole of the patients in each 
ward, exclusive of corridors or galleries. 

Position of Day Booms. 

19. The day rooms should be so arranged as to afford ready commu- 
nication with the grounds, and those appropriated to the aged and infirm 
should be on the lowermost stories. 

Attendants' Booms. 

20. Rooms should be provided for two or more attendants to each 
ward, and single attendants' rooms should not be of less dimensions 
than one hundred and twenty feet, and whenever practicable, these 
should be placed between two dormitories, with glazed doors of com- 
munication. 

Windows. 

21. The windows of the day rooms and corridors should be large and 
of a cheerful character, and every one be made to open easily, and so as 
to allow a free circulation of air, but not so far as to expose patients to 
danger. The wall below should not be sloped or splayed, but recessed, 
to admit, if requisite, of a seat. In the dormitories and single rooms the 
windows should, as a general rule, not be placed more than four feet 
from the floor. 

Shutters. 

Sliding shutters should be provided for a majority of the single sleep- 
ing rooms. 



129 

Doors. 

22. The doors of the single rooms should open outward, and be so 
hung that when open they will fold back close to the wall. 

Lavatories, Baths, and Water Closets. 

23. In each ward there should be conveniences for washing the person, 
a slop room containing a sink, a store room or closet, water closets, and 
a bath. (In many instances the bath? room may be so arranged as to be 
available for two or more wards.) It is very desirable that all water 
closets, lavatories, etc., should be placed in projections. 

Infirmaries. 

24. Suitable infirmaries, in the proportion of at least one tenth of the 
whole, should be provided in which the cubical contents of the sleeping 
rooms should be greater than in other parts of the building; and every 
room, including the single rooms, should have an open fireplace. A 
small day room in each infirmary is also desirable. 

Warming. 

25. All the day rooms and galleries should be warmed by means of 
open fireplaces, or open fire stoves, and in large rooms two fires should 
be provided. Fireplaces should also be built in all associated dormi- 
tories. In large rooms, such as the chapel or general dining hall, and 
in the corridor, further provision for warming may be necessary by 
means of some simple system of hot water joipes in connection with the 
open fire stoves or fires. 

Ventilation. 

26. The ventilation generally should be provided for by means of flues 
taken from the various rooms and corridors into horizontal channels 
connecting with a perpendicular shaft, in which a fire box should be 
placed for the purpose of extracting the foul air. 

Smoke Flues. 

27. In all cases where descending or horizontal smoke flues are used, 
they should be entirely constructed of brickwork, rendered or pargetted 
inside and out; and flues from any of the heating or other furnaces, 
which are carried up through any of the main walls, should be con- 
structed with a hollow space round them to prevent the inconvenient 
transmission of heat into the building during the warm periods of the 
year, and to allow of a moderation of the temperature of the building 
at other periods, when, owing to a change in the atmosphere, it may 
become inconveniently hot. 

Ventilating Flues. 

28. Whenever ventilating flues are constructed of inflamable material, 
such a quartering, lathed and plastered a distance of at least twenty 

17 



130 

feet from their point of connection with any shaft, furnace, rarifiying 
chamber, or smoke flue, must be constructed entirely of brick, stone, or 
other fireproof material. The rarifying chamber for ventilation, 
together with, the adjoining roof, must be entirely fireproof; and a com- 
munication should be made with it by means of a slate or iron door 
frame. 

Drainage. 

29. The best and most approved system of pipe or tubular drainage 
should be adopted, with a sufficient fall, so as effectually to carry off to 
a sufficient distance from the asylum the soil and all other impurities; 
and the sewerage should be collected in closed tanks, and so placed and 
constructed as to render the contents available for agricultural purposes. 
Means of flushing should be provided. 

Airing Courts. 

30. The inclosed airing courts need not be more than two in number 
on each side, and should be of ample extent, so as to afford proper means 
for healthful exercise. They should all be planted and cultivated, and 
any trees already existing within them should be preserved for shade. 
The walls should be sunk in a haha. 

Rainwater. 

31. The whole of the rainwater from the building should be collected 
in tanks suitably placed, for the purposes of the washhouse, and if pos- 
sible, at such levels as will dispense with the labor of pumping. Lead 
is an objectionable material for pipes and reservoirs, as adulterating the 
water. 

Lightning Conductors. 

32. Lightning conductors should be placed on the most elevated parts 
of the building, and they may be connected with the stacks of iron rain 
water pipes, which in that case should be fixed so as to answer the double 
purpose of rain water pipes and lightning conductors. 

Farm Buildings. 

33. Farm buildings, with suitable stables, etc., for visitors' horses, 
should be provided. 

No. 3 — Plans Bequired. 

1. One or more sheets of the ordnance map containing the county, 
borough, or district, in respecb to which the asylum is to be erected, or 
some other large map, in which the situation of the proposed asylum and 
all the public roads and footpaths in the vicinity thereof are fully de- 
fined. 

Scale of 100 feet to an Inch. 

2. A general plan of the land (with the block of the buildings and 
offices) and of the exercise grounds, garden, and road of approach, with 
the levels of the surface of the ground at the quoins of the building, 
offices, and fence walls figured thereon. 



131 

Scale of 20 feet to an Inch. 

3. Plans of the basement, ground, and each, other floor of the building 
and offices, also of the roofs and gutters and of the principal elevation. 

Scale of 10 feet to an Inch. 

4. Elevation of portions of the j>rincipal front, and. also of any other 
parts in which any variation therefrom takes place. 

Scale of 5 feet to an Inch. 

5. Transverse and longitudinal sections or sufficient portions thereof 
to show the construction of every portion of the building. 

Scale of 1 foot to one half an Inch. 

6. Plan and section of one separate sleeping room, dormitory, and eat- 
ing or day room respectively, or of part of the same, showing the method 
of warming and ventilating each; also, of the baths and washing j-ooms 
and water closets, and the construction of the apparatus for each. 

7. An abstract of the draft, contract, and specifications, giving a con- 
cise statement of the whole of the intended work, and also a detailed 
estimate of the building, and the prices at which the different materials 
and workmanship have been calculated in making the estimate. 

8. The thicknesses of the walls, and the scantlings of the timbers of 
the floors and roofs to be figured. 

9. The general system of heating and ventilation proposed to be 
adopted throughout the asylum, to be fully described in the drawings 
and specifications. 

10. Each plan to show the several classes and number of patients to 
be accommodated in the wards, day rooms, dormitories, cells, galleries, 
and airing courts, respectively, to which each plan relates. 

SUGGESTIONS OF THE SCOTCH BOARD. 

The following suggestions and instructions by the Scotch Board of 
Commissioners are the only ones differing from those by the English 
Commissioners: 

Suggestions and Instructions in Reference to (1) Sites; (2) Construction and 
Arrangement of Buildings; (3) Plans of Lunatic Asylums; by the Commis- 
sioners in Lunacy for Scotland. 

Locality. 

(First part of description same as for England and Wales.) The 
asylum should be within 'such distance of a town as to command the 
introduction of gas, water, etc., and of one of sufficient size to afford 
the means of amusement and recreation for the medical staff, the attend- 
ants, and such of the patients as might derive benefit from a change in 
the asylum routine. 

Supply and Quality of Water. 
(First part, same as for England and Wales.) The quantity, exclusive 



132 

of rain water, which should be collected in cisterns on the roof, should, 
at the dryest season, be not less than forty gallons per patient per diem, 
and the amount should be accurately gauged. 

No. 2 — Construction and Arrangements of Buildings — Entrance and Offices 

to the North. 

2. There should be no road of approach or public entrance traversing 
the grounds. 

The general entrance, the porter's room, the reception rooms, the 
committee room, the store rooms, and the other offices should be so 
placed as not to interfere with the amenity of the buildings occupied by 
the patients. 

Buildings for Working Patients — For Idiotic and Epileptic Patients — 

Cottages. 

6.' (First part, same as for England and Wales.) Provision of an 
equally simple and inexpensive description might also be made for a 
portion of the idiotic, imbecile, and fatuous patients, and also for chronic 
cases; or cottages might be erected for the accommodation of a large 
proportion of the working and inoffensive patients, who might be placed 
either under the care of the families of the attendants, or of cottage 
tenants of the asylum. 

• Position of Chapel. 

8. The chapel should be of easy access, and it should be capable of 
comfortably accommodating at least three fourths of the patients. 
(Kemainder of description same as for England and Wales.) 

General Dining Hall, Library, and Beading Boom. 

9. A general dining hall, conveniently situated with reference to the 
kitchen, should be provided for the patients of both sexes; and also a 
library and reading room, capable of serving for the general purposes of 
instruction and recreation. 

Arrangement of Bay Booms and Dormitories. 

12. Passages of communication of moderate width should be adopted 
in lieu of wide corridors, and the day rooms and dormitories should be 
placed on one side, and to the south. Under certain circumstances 
the day rooms and dormitories may occupy the whole breadth of the 



building. 



Cottages. 



32. The cottages, if adopted, should be of different sizes, each calcu- 
lated to accommodate from three to five patients, in addition to the 
family of the occupier. The male patients should be placed either in 
single rooms or in dormitories for three or four, and each cottage should 
contain a water closet. 

Farm Buildings. 

33. Farm buildings, with suitable stables, etc., should be provided, and 



133 

also workshops, suitable for the employment of the patients according 
to the prevalent occupations of the district. 

English Commissioners on Size of Hospitals. 

The English Commissioners of Lunacy are of opinion that an asylum 
to contain four hundred to five hundred patients is the best size, but 
that on an emergency they may be enlarged to contain six hundred to 
seven hundred patients without sacrificing the special characters which 
all modern asylums should possess. When there are more than seven 
hundred patients, the expenses increase, and all individual treatment 
vanishes. The Superintendent can only know the patients en masse, and 
not individually, and the establishment grows out of effective super- 
vision, although the number of attendants may be increased. This 
opinion may be found in the reports of the Commissioners again and 
again stated during the last ten years. Thus, in eighteen hundred and 
fifty-seven they state: 

" It has always been the opinion of this Board that asylums beyond 
a certain size are objectionable. They forfeit the advantage — which 
nothing can replace, whether in general management or the treatment of 
disease — of individual and responsible supervision. To the cure and 
alleviation of insanity few aids are so important as those which may be 
derived from vigilant observation of individual peculiarities; but where 
the patients are so numerous that no medical officer can bring them 
within the range of his personal examination and judgment, such oppor- 
tunities are altogether lost, and amid the workings of a great machine 
the physician, as well as the patient, loses his individuality. When to 
this also is added, what experience has of late years shown, that the 
absence of a single and undivided responsibility is equally injurious to 
the general management, and the rate of maintenance for the patients 
in the large buildings has a tendency to run higher than in buildings of 
a smaller size, it would seem as if the only tenable plea for erecting 
them ought to be abandoned. To the patients, undoubtedly, they bring 
no corresponding benefit. The more extended they are, the more 
abridged become their means of care; and this, which should be the first 
object of an asylum, and by which alone any check can be given to the 
present gradual and steady increase in the number of pauper lunatics 
requiring accommodation, is unhappily no longer the leading character- 
istic of Coiney Hatch or Hanwell." 

The Scottish Commissioners are equally opposed to large asylums. 
They consider that no asylum should contain more than three hundred 
and fifty patients; that the individual treatment of a larger number is 
impossible; and that cost increases with anything above that number. 
These opinions they repeatedly expressed in their various' reports. 

M. Parchappe, lately Inspector of Asylums in France, says: 

"After taking every consideration into account, I think the minimum 
of patients ought to be fixed at two hundred, and the maximum at four 
hundred. Below two hundred the economical advantages rapidly decline 
without compensatory benefit; above four hundred, although the 
economical advantages augment, it is at the detriment of the utility of 
the institution in its medical character." 



134 

M. Guislain, the eminent Belgian authority, in his large work on 
insanity, which is quoted by Doctor Arlidge, says : 

" It would be absurd to bring together, in the same place, a very large 
population. It would tend to foster an injurious degree of excitement, 
would render the management difficult or impossible, would destroy the 
unity of plan, and neutralize all scientific effort. The maximum number 
ought not to exceed three hundred or three hundred and fifty insane 
persons." 

Doctor Arlidge, in his work on " The State of Lunacy," mentions the 
opinions of Eoller and Damerow — two of the most eminent of German 
alienist physicians — on this subject, both of whom consider that asylums 
for acute cases should be limited to two hundred and fifty, but that those 
for both acute and chronic cases may admit from four hundred and fifty 
to five hundred inmates, but no more; and at page one hundred and 
eighteen states his own opinion that -six hundred " represent the maxi- 
mum which can economically and with just regard to efficient govern- 
ment and supervision, and to the interests of the patients, be brought 
together in one establishment." 

OBSERVATIONS ON FOREGOING PROPOSITIONS. 

We have preferred the suggestions of associations and the recom- 
mendations of bodies of men high in authority to anything we might 
have' said on these subjects, for the reason that they will be justly 
regarded as the results of wisdom and experience, worthy of attention 
and thoughtful consideration; whereas the same suggestions from us 
might be considered as the expression of individual opinion, carrying 
with it no weight of authority. The good of the cause is what we desire 
to promote, and for this reason have not hesitated in any instance to 
make free use of the ideas or words that the wisdom of others have 
given to the world. With no experience of our own, we have endeavored 
to carry out the instructions of our mission — to collect, compile, and 
report the result of other men's experience. We have, of course, 
exercised our own judgment in drawing conclusions, after listening to 
the arguments and observing the particular operations of theories; and 
all of our deductions have been made upon this basis. When we say, 
therefore, that the next asylum should be established for the accommo- 
dation of the City of San Francisco and the counties around the Bay, 
and on this account should be located in that vicinity, we are only carry- 
ing out the ideas of others, and obeying a law of common sense and 
universal experience; and when we suggest that another asylum will be 
necessary in the northern and still another in the southern portion of 
the State, ere many years shall have elasped, it is in obedience to the 
dictates of the same ideas and natural laws. It will be seen from the 
foregoing suggestions that the English Board of Commissioners in 
Lunacy regard hospitals that will accommodate from four to six hun- 
dred as the best size for the pauper class of patients; while in Scotland, 
owing possibly to the fact that both private and pauper patients are 
more generally received in the same asylums than in England, the Board 
expressed the opinion that three hundred and fifty should constitute the 
largest number that could be properly accommodated in one institution. 
The best authorities at this time in France, Germany, Switzerland, Italy, 
and Belgium have placed the limits at four hundred, F and in the United 



135 

States, until very recently, the Superintendents, in their collective 
capacity, declared that two hundred and fifty should never be exceeded. 
But in eighteen hundred and sixty-six they so far modified this 
expression as to say that under certain peculiar . circumstances the 
number might be carried to the extent of accommodating six hundred 
patients. 

This concession was made, as we have been informed by most of those 
giving their consent to its utterance, more to what seemed to be a 
necessity, than from convictions of propriety, most of them still adher- 
ing to the correctness of the original declaration — such too, as will be 
seen from the Massachusetts Eeport on Insanity and Idiocy, page one 
hundred and thirty-four, a copy of which will be found in our State 
Library, was the opinion of most of the Medical Superintendents in 
Europe and America at the time that report was written. 

PRESENT CUSTOM IN ALL COUNTRIES. 

Notwithstanding the modifications that have been made in this respect, 
and notwithstanding the further fact that most of the asylums being 
erected at the present time are intended for the accommodation of from 
four hundred to six hundred, both in the Old World and the New, our 
observations of the practical workings of asylums of all sizes, compels 
the conviction that all things taken into consideration the smaller num- 
ber — two hundred and fifty — is the best; and that under no circum- 
stances should this number be exceeded under one roof. If this should 
be deemed too small, it might with propriety be supplemented by addi- 
tional separate buildings for the accommodation of one hundred and fifty 
more; one with a capacity for fifty patients of the convalescent class, for 
both sexes, and two others of equal size — one for the inoffensive and 
quiet males, who may or may not labor on the farm, in the garden, or 
shops, and the other for females of the same class, who may work in the 
laundry or sewing room. Such buildings may be seen at many of the 
asylums in England and Scotland, as well as on the Continent, and are 
not only pleasant features, but are considered of so much value in the 
treatment of the patients, and the general management of the asylums, 
that we were assured by the Superintendents that they would not dis- 
pense with them on any account. They are by no means uniform in 
the proportious which they accommodate, nor as to the classes we have 
specified above. They are usually more cheaply constructed than the 
main buildings, and free from the grated or barred windows and other 
necessary arrangements made use of in the main building as precautions 
against escape or injury. They are warmed by open fireplaces, and are 
surrounded by their own little gardens, -redolent with flowers and beau- 
tified with shrubs cultivated by the patients. Of course they are never 
left to themselves, as it is a universal law that no ward of a hospital 
should, under any circumstances, be left without an attendant, even for 
a short time; otherwise serious accidents might be the result. 

DINING HALLS IN EUROPEAN ASYLUMS. 

In Great Britain and Ireland, as well as on the the continent, the pa- 
tients take their meals in a common dining hall, the males occupying 
seats on one side the hall and the females on the other. When the num- 
bers are too great for this arrangement to be practicable, two dining 
halls are provided, one for either sex, and are situated on either side of 



136 

the kitchen. At Newcastle-upon-Tyne they not only dine in the same 
hall, but. sit where they please; and it was interesting to observe that 
while the first tables on the female side of the room were occupied 
exclusively by them, and so with the males on their side, that the next 
set of tables had a sprinkling of the opposite sex, and so on till the cen- 
tre tables were reached, which were occupied by about an equal number 
of either sex. Doctor Wickham informed us that this was always the 
case, and that he had never experienced the least excitement or trouble 
on this account. For these reasons the patients occupying the detached 
buildings of which we have spoken resorted to the common dining halls 
for their meals, with the exception of the convalescent patients, who 
were in some instances provided with meals in their own establishment. 

ASYLUM SHOULD NOT BE ENLARGED. 

When an asylum of this size has received its intended complement, 
instead of building still further additions, another should be established 
in another district of the State, where the population most strongly indi- 
cates its need, whether at some other point upon the B^y — should San 
Francisco still continue to pour its hordes into the new asylum as it has 
done into the old — or in some more distant part of the State, in the 
great north or the mild and genial south, must be determined by the 
condition of things as they may exist at the time. Of one thing we are 
positively certain, that so long as the habits of our people remain as 
they have been; so long as the proportion of the foreign population 
remains the same; so long as the causes of insanity remain unchanged, 
just so long will insanity continue to be produced and hold its present 
ratio to the inhabitants of the State. 

ONE INSANE TO FOUR HUNDRED AND FIFTY OR FIVE HUNDRED PERSONS. 

We may as well make up our minds now as at any future time that 
every community of four hundred and fifty or five hundred persons will 
have to support or provide for the treatment and care of one insane per- 
son. When this becomes to be a recognized fact among the people, the 
whole subject will have been stripped of more than half its difficulties 
and embarrassments, the system for which we have labored will have 
been established, and the just and regular provision for the insane will 
be made for their support, as it is now for the common schools or the 
ordinary and inevitable expenses of the State Government. Until this 
has been accomplished the constantly recurring and ever renewing ques- 
tion of provisions for the insane will be brought before our Legislature, 
to occupy its time and perplex its members. 

ASYLUM AT STOCKTON OVERCROWDED. 

But there is another question that must not be overlooked, in our so- 
licitude for the establishment of a new asylum, and which is a matter of 
equal concern. It is the present crowded condition of the asylum at 
Stockton. With accommodations for not more than six or seven hundred 
patients, there are packed in its wards about eleven hundred — or four 
hundred more than it can properly accommodate. Doctor Shurtleff tells 
us in his report, " that beside two patients in the rooms intended for but 
one, in eight out of the eleven wards, two hundred and twenty-seven 
patients are sleeping on beds nightly prepared for them in the halls." 



137 

Two of these wards, the second and tenth, intended for thirty patients 
each, now have about eighty each. These wards are poorly ventilated, 
low, and uncomfortable in the extreme, and should be erased from the 
face of the earth and the memory of man. They never were fit recep- 
tacles for any human being, and have been tolerated altogether too long. 

INCREASED MORTALITY. 

To the crowded condition of these wards and the hospital generally 
must be attributed the increased mortality of the last four years; and 
should it be our misfortune, which God forbid, to be visited with cholera 
or other epidemic, there is no place to which these patients could possibly 
be removed, and they would consequently be swept away like sheep with 
the rot. Let any member of the Legislature visit these wards at bed- 
time, and if he does not conclude that it is a sin and a shame not to do some- 
thing for their immediate relief, we will be willing to acknowledge that we 
ourselves have lost our reason and our heart, and a fit subject for the 
very wards that we have described, or that he himself is in such condi- 
tion; for no two sane men could ever agree to the policy of "doing 
nothing," after having visited them. 

How Dr. Shurtleff and his assistants have managed to get along so 
well, under the disadvantages with which they have been constantly 
beset, is a matter of wonder and surprise, and the untiring energy 
and constant watchfulness that has been displayed by them are wor- 
thy of the highest commendation, as well as the gratitude of the com- 
munity at large. 

NEW BUILDINGS SHOULD BE FINISHED. 

The new building at Stockton is of the most creditable character, and 
when completed would be considered a first class asylum anywhere in 
the world; indeed, with a few modifications, we know of none that 
would be better suited to the climate in which it is located. The press- 
ing demands for further and immediate room, make it of the greatest 
importance, nay, an absolute necessity, that it should be completed by 
the immediate construction of the north wing, and thus finish the work 
that has been too long delayed. It is not necessary to stop to discuss 
the question as to whether Stockton is or is not the proper place for the 
location of an insane asylum. One has been located there, and has been 
in successful operation for the last twenty years. It could not be 
removed, even if such an event were desirable. We therefore heartily 
indorse all that Dr. Shurtleff has said with regard to the necessities of 
the institution over which he has so long presided, with such marked 
ability and success. 

OTHER PROVISIONS NEEDED. 

The strongest reasons and the plainest motives of sound policy would 
indicate the propriety of providing for the improvements at Stockton, 
and for a new asylum in the same bill. The past experience of Doctor 
Shurtleff, aided by his Board of Trustees, would insure the completion 
of the work there in the shortest time and best manner; when it would 
only remain for the Governor or the Legislature to make a judicious 

18 



138 

selection of the men who are to choose the site, decide upon the plan, 
superintend 'the erection of the new building, and control its subse- 
quent management. 

COMMISSIONERS. 

As great power is commonly placed in the hands of these individuals, 
it will readily be understood how important it is that they should be 
men of high character, strict integrity, active benevolence and business 
habits. They should be willing to inform themselves of the character 
and responsibility of the high trust confided to them, and should heartily 
avoid taking any step that might mar to a greater or less extent the 
usefulness of the institution as long as it may exist. 

SITE. 

Great caution should be observed in the selection of a site, as the best 
style of building and most liberal organization can never compensate 
for the loss sustained by a location that deprives the patients of valuable 
privileges, or subjects them to annoyances; nearness to manufacturing 
establishments, houses of correction, penitentiaries, or other public insti- 
tutions calculated to disturb the quiet or unpleasantly affect the mind 
of the patients should be especially avoided. Great stress is laid upon 
all of these matters both by the Commissioners of England and the 
Superintendents of our own country. As has been observed by Doctor 
Kirkbride, than whom no better authority can be found: "It is now 
well established that this class of hospitals should always be located in 
the country not within less than two miles of a town of considerable 
size, and they should be easily accessible at all seasons. They should, 
if possible, be near turnpikes or other good roads, or on the line of a 
railroad. While two or three miles from a town might be named as a 
good distance on the former, the facilities afforded by a railroad might 
make ten or twelve miles unobjectionable; for it is the time spent in 
passing and ease of access that is most important. Proximity to a town 
of considerable size has many advantages, as in procuring supplies, 
obtaining domestic help, or mechanical workmen, and on account of the 
various matters of interest not elsewhere accessible to the patients. In 
selecting a site, facility of access from the districts of country from 
which the patients will be principally derived should never be over- 
looked." 

SHOULD BE IN A HEALTHY LOCALITY. 

The building should be in a healthful, pleasant, and fertile district of 
country; the land chosen should be of good quality and easily tilled; the 
surrounding scenery should be of a varied and attractive kind, and the 
neighborhood should possess numerous objects of an agreeable and inter- 
esting character. While the hospital itself should be retired, and its 
privacy fully secured, it is desirable that the view from it should exhibit 
life in its active forms, and on this account stirring objects at a little 
distance are desirable. Eeference should also be made to the amount of 
wood and tillable land that may be obtained, to the supply of water, and 
to the facilities for drainage, and for inclosing the pleasure grounds. 

QUANTITY OP LAND NECESSARY. 

While it is the duty of the State to provide for and take care of every 



139 

citizen who may be afflicted with insanity, on the other hand it is no 
more than right that they should make the burden as light as possible ; 
and although we do not believe in making patients work for the profits 
of their labor, yet when they have been accustomed to labor on the 
farm, in the garden, or in shops at home, and when they are well enough 
to perform this labor at the asylum, not only without detriment but with 
advantage to their health and improvement in their mental condition, it 
should be exacted from them; the Superintendent in all cases being the 
judge as to the results. In most of the asylums in our country too little 
employment is given to the body, and too little occupation to the mind, 
to prevent a state of ennui that naturally follows the occupation "of 
doing nothing." 

Many cannot labor for medical reasons; others, on account of previ- 
ous occupations and professions, have not been taught to labor, and 
require other forms and methods of employment; yet all in whom there 
exists no special reason contraindi eating it should be employed in some 
way during a portion of every day. 

Hence every State Asylum should have at least half an acre of land 
for each patient intended to be accommodated, not only for farming and 
gardening purposes, but for pleasure and exercise grounds as well, as 
the latter are the most beautiful and attractive features of every asylum 
where they exist, and in which the English Asylums especially, so far 
excel those of all other countries as a rule, and those in our country 
more particularly, where this feature has been too much neglected. 

Supply of Water. 

An abundant supply of good water is one of the necessaries of every 
hospital, and should be secured whatever may be the cost or trouble 
required to effect it. A very extensive use of baths is among the most 
important means of treatment, and the large number of water closets 
that are indispensable in the wards, the great amount of washing that is 
to be done, as well as various other arrangements requiring a free use 
of water, and above all, abundant means for extinguishing fire, in case 
such an accident should occur, make it of the utmost importance that 
the supply should be permanent and of the most liberal kind. 

The daily consumption for all purposes in an institution for two hun- 
dred and fifty patients will not be much, if any, less than ten thousand 
gallons, and tanks to contain more than this amount should be placed in 
the dome, or highest part of the building. 

Drainage. 

All the drainage should be under ground; and in selecting a site, facil- 
ities for making this very important arrangement should never be over- 
looked. All the waste water from the kitchen, sculleries, baths, water 
closets, etc., should be carried off beneath the surface, and to such a 
distance as will prevent the possibility of its proving an annoyance to 
the hospital. 

All the entrances to the culverts should be trapped, and the culverts 
should be made so large and with such a descent as will obviate all risks 
of obstructions. If the rain water from the roof and the surface drainage 
are taken in another direction, that from the hospital may be made to 
add greatly to the fertility of the farm; but it is much better to carry 
all off through the same culvert and lose this advantage, than incur the 



140 

slightest risk of having the air in the vicinity of the hospital contami- 
nated by these fertilizing arrangements. 

Inclosures. 

It is desirable that the pleasure grounds and gardens should be securely 
inclosed, to protect the patients from the gaze and impertinent curiosity 
of visitors, and from the excitement occasioned by their presence in the 
grounds. 

This inclosure should be of a permanent character, about ten feet 
high, and so located that it will not be conspicuous, even if it is at all 
visible from the building. The site, as well as the position of the building 
on it, should have some reference to this arrangement. If sufficient ine- 
qualities of surface exist, the wall or fence, as it may be, should be placed 
in the low ground, so as not to obstruct the view; but if the country is 
too level to admit of this, the same end may be attained by placing the 
wall in the center of a line of excavation of sufficient depth to prevent 
its having an unpleasant appearance, and yet be entirely effective. 
Although the first cost of a wall will be about double that of a fence of 
the proper kind, still, its durability and greater efficiency in every re- 
spect will make it cheaper in the end. The amount of land thus inclosed 
should never be less than thirty acres, while forty or even fifty acres 
will be a more desirable amount, so that the pleasure grounds of the 
male and female patients, which, as before observed, should be entirely 
distinct, may be sufficiently extensive. Important as I regard the per- 
manent inclosure of extensive pleasure grounds and gardens, in the 
manner suggested, as protecting the patients from improper observation, 
keeping out intruders, enlarging the liberty of the insane generally, 
securing various improvements from injury, and permitting labor to be 
used as a remedy for more patients than could otherwise be done, still it 
is proper to add, that high walls around small inclosures, and in full 
view from the buildings, are even less desirable than a simple neat railing, 
which would neither keep determined visitors out nor active patients in. 
The first of these objects — keeping the public out — it must not be for- 
.gotten, is the prominent one thought of in recommending a wall to be 
placed around the pleasure grounds of a hospital. The presence and 
watchfulness of intelligent attendants must still be the grand reliance 
to prevent the escape of patients, and I regard any arrangement that 
does away with the necessity of constant vigilance undesirable about a 
hospital for the insane. 

Patients' Airing Courts. 

Although it does not seem to me desirable to have a large number of 
private yards in immediate connection with a hospital for the insane, it 
will still be found convenient to have two for each sex, of a large size, 
well provided with brick walks, shade trees, and such other modes of 
protection from the sun and weather as may be deemed useful. These 
yards enable many patients, who at certain periods wish to avoid the 
greater publicity of the grounds, to have the benefit of the open air, and 
to take exercise at hours when the attendants cannot conveniently leave 
the wards; but most of the patients should have a more active and 
longer continued kind of exercise than these yards afford. They should 
look to the walks in the open fields and about the grounds, which can 
readily be made a mile long for each sex for their principal exercise. 



141 

• 

Four fifths of all the patients will, under proper regulations, be able to 
take walks of this kind for at least a couple of hours, morning and 
afternoon, at all seasons; and in warm weather, when proper summer 
houses and seats are provided, they may thus profitably spend one half 
the entire day in the open air. It is always much better for patients to 
be comfortably seated in a pleasant parlor or hall at any season of the 
year than to be lying on the ground, or otherwise soiling their clothes, 
and exposing themselves to the risk of taking cold, as is very apt to be 
the case when certain classes are allowed to consult their own pleasure 
as to the mode of passing their time while in the small yards adjoining 
the building. 

Size of the Building. 

A suitable site having been selected, it will next become necessary to 
decide upon the size of the institution. Whatever difference of opinion 
may have formerly existed on this point, I believe there are none at 
present. All the best authorities agree that the number of insane con- 
fined in one hospital should not exceed two hundred and fifty, and it is 
very important iJMLt at no time should a larger number be admitted than 
the building is ^Rculated to accommodate comfortably, as a crowded 
institution cannot fail to exercise an unfavorable influence on the welfare 
of its patients. The precise number that may be properly taken care of 
in a single institution will vary somewhat, according to the ratio of 
acute cases received, and of course to the amount of personal attention 
required from the chief medical officer. In State institutions, when full, 
at least one half of all the cases will commonly be of a chronic char- 
acter, and require little medical treatment. Even when thus propor- 
tioned, two hundred and fifty will be found to be as many as the Medical 
Superintendent can visit properly every day, in addition to the perform- 
ance of his other duties. Whenever an existing State institution built 
for two hundred and fifty patients contains that number and does not 
meet the wants of the community, instead of crowding it, and thereby 
rendering all its inmates uncomfortable, or materially enlarging its 
capacity by putting up additional buildings, it will be found much better 
at once to erect an entirely new institution in another section of the 
State, for under any circumstances the transfer of acute cases from a 
great distance is an evil of serious magnitude, and constantly deplored 
by those who have the care of the insane. 

Position, Form, and General Arrangements. 

The size of the building having been determined, its form and general 
arrangements will next require attention; and no plan, however beauti- 
ful its exterior may appear, nor how apparently ingenious its interior 
may seem, should be adopted without having been first submitted to the 
inspection and received the approval of some one or more physicians who have 
had a large practical acquaintance with the insane, and who are thoroughly 
familiar with the details of their treatment, as well as with the advan- 
tages and defects of existing hospitals for their accommodation. So 
different from ordinary buildings or other public structures are hospitals 
for the insane, that it is hardly possible for an architect, however skill- 
ful, or a Board of Commissioners, however intelligent and well disposed, 
unaided to furnish such an institution with all the conveniences and 
arrangements indispensable for the proper care and treatment of its pa- 
tients. No desire to make a beautiful and picturesque exterior should 



142 

ever be allowed to interfere ..with the internal arrangements. The inte- 
rior should be first planned, and the exterior so managed as not to spoil 
it in any of its details. 

A hospital for the insane should have a cheerful and comfortable appear- 
ance; everything repulsive and prison-like should be carefully avoided, 
and even the means of effecting the proper degree of security should be 
masked, as far as possible, by arrangements of a pleasant and attractive 
character. For the same reason the grounds about the building should 
be highly improved and tastefully ornamented; a variety of objects of 
interest should be collected around it, and trees and shrubs, flowering- 
plants, summer houses, and other pleasing arrangements should add to 
its attractiveness. No one can tell how important all these may prove 
in the treatment of patients, nor what good effects may result from first 
impressions thus made upon an invalid on reaching a hospital — one who 
perhaps, had left home for the first time, and was looking forward to a' 
gloomy, cheerless mansion, surrounded by barren, uncultivated grounds, 
for his future residence, but on his arrival finds everything neat, tasteful^ 
and comfortable. 

Nor is the influence of these things on the friend|^ patients unim- 
portant. They cannot fail to see that neither labor nJJPkpense is spared 
to promote the happiness of the patients, and they are thus led to have 
a generous confidence in those to whose care their friends have been 
intrusted, and a readiness to give a steady support to a liberal course of 
treatment. 

Great care should be observed in locating the building, that every pos- 
sible advantage may be derived from the views and scenery adjacent, 
and especially from the parlors and other rooms occupied during the day. 
The prevailing winds of Summer may be also made to minister to the 
comfort of the inmates, and the grounds immediately adjacent to the 
hospital should have a gradual descent in all directions, to secure a good 
surface drainage. 

PROPOSITIONS RELATIVE TO THE ORGANIZATION OF HOSPITALS FOR THE 

INSANE. 

I. The general controlling powers should be invested in a Board of 
Trustees or Managers; if of a State institution, selected in such manner 
as will be likely most effectually to protect it from all influences con- 
nected with political measures or political changes; if "of a private cor- 
poration, by those properly authorized to vote. "* 

II. The Board of Trustees should not exceed twelve in number, and 
be composed of individuals possessing the public confidence, distin- 
guished for liberality, intelligence, and active benevolence, above all 
political influence, and able and willing faithfully to attend to the duties 
of their station. Their tenure of office should be so arranged that when 
changes are deemed desirable the terms of not more than one third of 
the whole number should expire in any one year. 

III. The Board of Trustees should appoint the Physician, and, on his 
nomination, and not otherwise, the Assistant Physician, Steward, and 
Matron. They should, as a Board, or by committee, visit or examine 
every part of the institution at frequent stated intervals, not less than 
semi-monthly, and at such other times as they may deem expedient, and 
exercise so careful a supervision of the expenditures and general opera- 
tions of the Hospital as to give to the community a proper degree of 
confidence in the correctness of its management. 



143 

IV. The Physician should be the Superintendent and chief executive 
officer of the establishment. Besides being a well educated physician, 
he should possess the mental, physical, and social qualities to fit him for 
the post. He should serve during good behavior, reside on or very 
near the premises, and his compensation should be so liberal as to enable 
him to devote his whole time and energies to the welfare of the Hospital. 
He should nominate to the Board suitable persons to act as Assistant 
Physician, Steward, and Matron. He should have entire control of the 
medical, moral, and dietetic treatment of the patients, th& unrestricted 
power of appointment and discharge of all persons engaged in their 
care, and should exercise a general supervision and direction of every 
department of the institution. . 

V. The Assistant Physician, or Assistant Physicians where more than 
one are required, should be graduates of medicine, of such character 
and qualifications as to be able to represent and to perform the ordinary 
duties of the Physician during his absence. 

YI. The Steward, under the direction of the Superintending Physi- 
cian, and by his order, should make all purchases for the institution, 
keep the accounts, make engagements with, pay, and discharge those 
employed about the establishment, have a supervision of the farm, 
garden, and grounds, and perform such other duties as may be assigned 
him. 

VII. The Matron, under the direction of the Superintendent, should 
have a general supervision of the domestic arrangements of the house, 
and, under the same direction, do what she can to promote the comfort 
and restoration of the patients. 

VIII. In institutions containing more than two hundred patients, a 
Second Assistant Physician and an Apothecary should be employed; to 
the latter of whom other duties, in the male wards, may be conveniently 
assigned. 

IX. If a chaplain is deemed desirable as a permanent officer, he should 
be selected by the Superintendent; and, like all others engaged in the 
care of the patients, should be entirely under his control. 

X. In every asylum for the insane there should be one supervisor 
for each set, exercising a general oversight of all the attendants and 
patients, and forming a medium of communication between them and 
the officers. 

XI. In no institution should the number of persons in immediate 
attendance on the patients be in a lower ratio than one attendant for 
every ten patients; and a much larger proportion of attendants will 
commonly be desirable. 

XII. The fullest authority should be given to the Superintendent to 
take every precaution that can guard against fire or accident within an 
institution, and to secure this an efficient night watch should always be 
provided. 

XIII. The situation and circumstances of different institutions may 
require a considerable number of persons to be employed in various 
other positions; but in every hospital, at least all those that have been 
referred to, are deemed not only desirable, but absolutely necessary to 
give all the advantages that may be hoped for from a liberal and enlight- 
ened treatment of the insane. 

XIV. All persons employed in the care of the insane should be active, 
vigilant, cheerful, and in good health. They should be of a kind and 
benevolent disposition; be educated, and in all respects trustworthy; 



144 

and their compensation should be sufficiently liberal to secure the ser- 
vices of individuals of this description. 

COMMENTS ON KIRKBRIDE'S VIEWS.* 

The foregoing views of Doctor Kirkbride on some of the most impor- 
tant of the many subjects connected with hospitals for the insane, their 
location, site, and organization, should be carefully considered. No 
man in America is better or more favorably known, and but few have 
had so successful a career or so large an experience. His opinions have 
been accepted by all as the best authority, and if not always concurred 
in, certainly always command attention. If we have imbibed some of 
his ideas it may not be regarded as strange or unexpected, since they 
are supported by reason and confirmed by experience. Others more 
experienced and able than we are have done likewise. If we differ with 
him on some points of importance, it is because other men of ability 
have impressed us with their views, and our observations have led us to 
different conclusions. We think, for instance, that no Board of Trustees 
for the management of an asylum should consist of more than seven 
members — five being still better than seven. Small Boards seem to be 
more efficient than large ones. They do not leave matters so much to 
each other, and thus neglect their duties. We believe that detached 
buildings for the purposes that we have suggested are desirable features 
in an asylum; he does not. But in most of his views we heartily concur, 
and only regret they are not as well known by the people as by the 
profession. Let us hope, at least, that they may be carefully weighed 
and duly considered by our legislative committees and Boards of Com- 
missioners. The subjects of ventilation, warming, lights, water closets, 
comparisons between the asylums of different countries, and many other 
matters of more or less interest, have been so completely and minutely 
noticed and discussed by Doctor Manning, and his conclusions ordina- 
rily so just as to challenge our approval on most subjects, that we are 
induced to incorporate the following sketch of his able and interesting 
report into our own. 



CHAPTEE X. 

INSANE ASYLUMS-DOCTOR MANNING'S REPORT. 

Synopsis of Doctor Manning's Report— Comments upon the same. 

SYNOPSIS OP DOCTOR MANNING'S REPORT. 

Doctor Manning commences his report, made in eighteen hundred and 
sixty-seven, to the Government of New South Wales, by considering 
briefly the various existing methods of providing for the insane, which 
he divides into five classes: 

1st. Indigent — supported mainly or wholly by local or General Gov- 
ernment. 

* Note. — See Kirkbride on Hospitals for the Insane. 



145 

2d. Non-pauper — supported by friends or from their own estates. 

3d. Criminal. 

4th. Idiots. 

5th. Inebriates. 

He speaks first of the provision made for them in private dwellings, 
especially in England, Scotland, France, and Belgium; thinks that even 
in Scotland, where there are peculiar advantages (from the character 
and sparseness of population) for this method of treatment, the fact that 
the number of insane thus accommodated has steadily diminished since 
the visitations of the Board commenced, is worthy of note; and alludes 
to the evils of this method (see p. 9). In a new country such a plan is 
altogether impracticable. Describes G-heel (pp. 9 to 14). 

Next treats upon farm asylums, and describes Clermont (p. 15), and in 
conclusion says: "A full examination of the system of farm asylums 
shows that it is economical, and calculated to promote the comfort and 
happiness, and be beneficial to the mental health of the inmates." 

Next, close asylums; speaks of the poorhouse wards, and quotes from 
Doctor Willard, of their miserable condition in the United States; then 
contrasts them with the State asylums; considers it "remarkable that 
proprietary asylums for pauper patients are unknown in America." 

Page 22 — Describes general construction and organization of asylums 
for paupers. 

1. Elevation of position; 

2. Aspect; 

3. Distance from town. 

Table of amount of land owned and cultivated by several asylums, p. 25. 
Before treating of asylum construction, considers the two questions: 

1. Separation of the acute and chronic cases; 

2. The size of asylums. 

Arguments for and against separation are presented on pages twenty- 
eight to twenty -nine. Dr. Manning says : " Upon the whole, it must be 
considered that the balance of argument is strongly in favor of one asy- 
lum, to contain both classes in such proportion as they occur in each 
district." 

In regard to size, he says: " For the new institutions on the continent, 
wherever placed, the maximum number is fixed at six hundred; and in 
many cases a much smaller size is preferred;" then presents two tables 
(p. 30) of asylums in England and of a few in Scotland, France, Ger- 
many, and United States, showing number of patients and rate of main- 
tenance. 

Treats of Construction under four heads: 

Form of building; 

Number of stories; 

Material; 

Architecture. 

Form — 1. Corridor, or ward form; 

2. House form; 

3. Block, or pavilion form; 

4. Cottage form. 

His objections to the corridor form are "that the asylum is spread over 
an immense area, is costly in construction from the immense length of 
corridor and roofing required, and from the absence of all those social 
and domestic arrangements which characterize an English home." 

19 



146 

• The advantages of the house form are "that the condition of the 
patient is assimilated to that of ordinary life by the separation of the 
sleeping accommodation from that required for the duties and employ- 
ments of the day, the supervision of the patients by the attendants is 
more complete, ventilation is more easy, since the windows and doors 
of the sleeping rooms from which the patients are removed can be kept 
fully open all day, and those of the day rooms, all night; whilst the 
cleaning, always a matter of difficulty in the ward plan, is rendered easy 
from the fact that the floors are in use at different times." 

The block or pavilion plan is " a still further development of the house 
plan." 

" As supplementing an ordinary asylum, the cottage system has worked 
admirably, but when fully employed the system has not, on the whole, 
been found to answer. The inconveniences which have been felt in this 
arrangement have been chiefly from difficulties of supervision owing to 
the large space over which the asylum, extends. The best form of 
cottages, whether for a complete asylum or as adjunct to an existing 
institution, are the l conjoined cottages ' designed by Mr. Stack and 
Doctor Campbell, at the Essex Asylum," (see p. 33 for description, and 
App. G, Nos. 10 and 11 for plans.) 

Page 34 — Water supply. This inquiry includes: 

1. The source and mode of supply; 

2. Quantity; 

3. Storage; 

4. Precaution against fire. 

As supplementary to this question are considered arrangements for 
the cleanliness of patients: 

1. Baths; 

2. Lavatories; 

3. Sinks; 

Their situation, material and fittings, and their number. The propor- 
tion of baths in English and American Institutes, about one to twenty 
patients; on the Continent, less. 

Page 38 — Drainage. 

Page 45 — Warming, by: 

1. Open fires; 

2. Hot air; 

3. Hot water; 

4. Steam. 

Page 47 — Lighting: 

1. Windows; 

2. Lamps. 

Examining windows is noted: 

1. Position and proportion to wall space: 

2. Material and method of opening; 

3. Size of panes; 

4. Guards and accessories, as shutters, etc. 

Page 52 — Yentilation, either artificial — by propulsion or extraction; or 
natural — by doors, windows, and fireplaces only, or by openings in addi- 
tion to these. 

Doctor Manning says; "it is noteworthy also that those with windows, 
doors, and fireplaces only, and those with the more simple accessories in 
addition to these, seem as well ventilated as those in which there is an 
elaborate arrangement of ventilating shafts." 



147 

Page 54 — Cubic space. — In the new asylum at Madras fifteen hundred 
cubic feet is the space fixed for European patients. 
Day and night accommodation: 

1. Day or sitting rooms. 

2. Dining rooms. 

3. Dormitories. 

4. Airing grounds. 

Considers the question of single rooms or common dormitories quite an 
important one. It is universally agreed that violent, noisy, dirty 
patients should be accommodated in single rooms, but it by no means is 
decided what proportion of patients it is necessary to isolate thus. 

Page 59 — Floorings, fittings, and furniture of rooms. 

Page 64 — Staircases and stairs, bells. 

Page 65 — -Treats of the different provisions made in asylums for con- 
valescents and quiet patients, for the sick and infirm, and for the violent and 
excited. " The proportion of violent patients for which provision is gen- 
erally made would appear to be about one tenth." 

Kitchens, laundry, chapel, dead-house and cemetery, amusement room, 
library, are each considered separately in turn, followed by a brief 
notice of the provision made for employes of all classes. 

Page 75 — Organization and government, which Dr. Manning considers 
"even of greater importance than asylum construction;" reviews briefly 
the method in use in different countries, and concludes: 

" On examining closely the general condition of asylums, those are 
almost always found to be best managed in which the physician is the 
Superintendent, one and supreme; in which the committee of visitors act 
only through him and with his advice, and in which the appointment 
and dismissal of all attendants are delegated to him; and those are found 
to be least satisfactory in which the responsibility is divided; in which 
the committee of visitors or controlling Board meddle in the internal 
management of the institution, and direct, themselves or through other 
officers, any part of it, appoint or dismiss attendants, or clip in any way 
the authority of the Medical Superintendent." 

Page 80 — Gives a table of the salaries of Superintendents in some 
English asylums and the number of assistants. 

Then follows a consideration of each of the classes of subordinate 
employes. 

Page 84 — Table of proportionate number of attendants to patients in 
the principal asylums of England, France, Germany, Holland, and the 
United States. Ages of attendants (in English asylums), from eighteen 
to thirty-five; generally deemed advisable that they should not be under 
twenty-one. Discusses the desirability of placing attendants in uniform, 
but expresses no decided opinion. Diet of attendants and the privileges 
allowed them follows. 

Page 88 — Artisans and servants. 

Page 91 — Hospital dietary, followed by considerations as to clothing 
of patients; next, labor — several tables relative thereto being given; 
then follows amusement and school; classification of patients; animals 
kept at asylums; system of supply (commissariat); provision for relief 
of patients on discharge; asylum reports. 

Page 108 — Statistics. 

Page 116 — Eestraint and seclusion. — Doctor Manning quotes from 
Doctors Bucknill, Wilkes, Ewerts, Meyer, Kirkbride, and Gray, and 



148 

shows the practice in many asylums. He says: "During the last few 
years there has been a certain reaction in the feelings of Superintendents 
of asylums on this subject. In quite half of the asylums visited, 
although restraint was not practiced, its advantage in certain cases was 
distinctly admitted, and it does not now meet with the all but wholesale 
condemnation which was accorded to it some few years ago." After 
speaking of the use of the shower bath, he concludes as follows: 

" It is not a little curious that owing more or less to popular clamor, 
and to a fear of the abuses to which they are liable, mechanical restraint 
has been virtually abandoned in Great Britain, and the shower bath has 
ceased to be used in America, and so a mode of treatment useful in a 
certain number of cases is lost to the physician in each country." 

Page 122 — Accommodation for patients paying for their maintenance. 
Page 125 — Criminal lunatics; which are divided into two classes: 

1. Those who whilst insane commit criminal acts. 

2. Those who become insane while undergoing punishment. 

He treats of the distinction made between these classes and the man- 
ner in which they are provided for; thinks that Scotland is broader in 
principle and has been more successful in her treatment of this class; 
then describes at considerable length the Broadmoor Criminal Asylum 
and the Criminal Lunatic Asylum at Perth, Scotland. 

Page 139 — Asylum for idiots. 

Page 148 — Asylum for inebriates. 

Page 154 — Suggestions, from which are quoted the following para- 
graphs : 

" The moral and material advantages which follow the system of pro- 
vision for the insane in private dwellings are undoubted." 

"It is necessary that population should so increase as not only to 
form aggregate bodies, towns, and villages, but to form a united, related, 
fixed, and settled people; and that the masses shall have received a cer- 
tain education on lunatic matters, by public papers and by the existence 
of well conducted asylums, before the separate system is adopted. An 
attempt to place any large number of the insane in private dwellings 
must necessarily fail in a new country, colony, or State. Neither the 
Belgian system nor the Scotch is possible in New South Wales at present, 
but the advantages of these should be ever kept in view, and the whole 
asylum organization should tend towards the development of such sys- 
tems in the maturer age of the colony." 

"The close asylum, however, has been in long years past, and must be 
in the years yet to come, the chief method in which the insane of all 
countries, in the acute stages of their maladies, are provided for." 

Page 157 — Doctor Manning quotes from Doctor Wilson, the Catholic 
Bishop of Hobart Town, in reference to locating a hospital near a large 
city, as follows: 

" The advantages of having a hospital near a large city are incalcula- 
ble. Here are a few: 

" 1. The securing judicious visitation of a properly selected Board of 
Commissioners for the general management of so important an institu- 
tion, a measure absolutely necessary for its permanent well working. 



149 

" 2. The means of procuring the best medical and surgical assistance 
when required. 

" 3. The opportunity afforded almost daily to convalescent, quiet, and 
orderly patients of visiting the city for amusement, going through the 
markets, sometimes strolling through the public pleasure grounds, and 
obtaining that change so beneficial to them, both mentally and phy- 
sically. 

"4 % Affording facility to humane and well qualified persons of grati- 
fying in the asylum, not unfrequently of an evening, patients whose 
minds are in a state to profit by such kind offices, with music, instru- 
mental and vocal, recitations of short and cheerful pieces, or appropriate 
readings, and such like friendly acts. 

" 5. Of affording patients likely to profit by such visits the means of 
attending such public exhibitions in the city as offer from time to time 
suitable for them. Many other advantages might be mentioned." 

On page one hundred and sixty-six Doctor Manning says: 

" The site to be chosen for an asylum is a matter of primary impor- 
tance. On it must depend in no small degree the comfort, happiness, 
and health, both mental and bodily, of the inmates, as well as the cost of 
the institution and the whole workmg of its internal economy. 

"An elevated position is desirable, because more healthy — command- 
ing, as a rule, more extended views, both from the rooms and airing 
grounds, and affording greater facilities for drainage and ventilation. 

" In the suggestions and instructions to architects, issued by the Com- 
missioners for England and Scotland, it is suggested that 'it should not 
be near to any nuisances, such as steam engines, shafts of mines, noisy 
trades, and offensive manufactories; neither should it be surrounded, or 
overlooked, or intersected by public roads or footpaths;' 'that the site 
of the building should be elevated as respects the surrounding country, 
and, if to be obtained, undulating in its surface and having a fall to the 
south.' " 

Doctor Manning continues: 

"The subsoil should, if possible, be calcareous, gravelly, or rocky; 
but if the position is elevated and the drainage good, a clayey subsoil, 
such as is occupied by more than one of the best English asylums, is not 
objectionable." 

The advantages to be derived from proximity to a large town are : 

1. Facility of access for patients and their friends, Commissioners, Inspec- 
tors, and other Government officials, medical officers, etc. 

2. Diminished cost of conveyance of coal, stores, and provisions. 

3. Facility for amusement of patients. 

4. Supply of gas and water. 

5. Increased facilities for procuring good attendants and for inducing them 
to remain for a longer time. 

The special need of the attendants (who are always with the insane) 
for change and amusement away from the institution is spoken of at 
considerable length. 

In reference to land, Doctor Manning recommends " the proportion of 



150 

one acre to every two patients," "instead of the minimum of one acre 
to every four patients, suggested by the British Commissioners." " The 
full amount which will be required for the institution, according to its 
estimated eventual extent, should, if possible, be acquired at once. It 
might either be cultivated by the patients in the institution, if sufficiently 
numerous for the purpose, partly cultivated by hired labor, or let on 
short lease till the number of patients was sufficient to work it; but as 
much as possible of it should be brought under cultivation — fruits, root 
or cereal crops, grown according to the nature of the soil, the wants of 
the institution, and the capabilities of the inmates. The more an asylum 
is self supporting in* this respect the greater will be the economy of 
expenditure. 

"It has been calculated that the labor of the insane is only equal to 
one fifth of that of the sane, so that one hundred patients are equivalent 
only to twenty healthy field laborers. In most asylums there will be 
found one inmate in every five suitable for field labor, so that in an asy- 
lum of five hundred patients, there will be about one hundred inmates 
capable of such employment. But if it is supposed that only half this 
number ci.n be so employed, it will be equivalent to the constant labor of 
ten healthy men; and what these are capable of effecting in agriculture 
and horticulture can be estimated by all those conversant with the 
matter." 

In regard to the question of the separation of acute and chronic cases, 
Doctor Manning says: "The solution of this, like many other practical 
questions regarding asylums, depends very much upon the population 
of the district, upon the nature of the existing buildings, and upon the 
special aims which it is intended to combine with their erection (e. g., 
clinical instruction). Wherever a large population is crowded within a 
small space, and two asylums can be made fairly accessible to the whole 
population of the district, the greatest argument against the separation 
of acute and chronic cases ceases to exist." 

In regard to the size of asylums, Doctor Manning quotes the opinions 
expressed by many eminent authorities, and concludes as follows: 

" Weighing well all the opinions of eminent men on this subject, and 
the arguments with which they are backed, and judging from personal 
inspection of existing asylums, the opinion may be expressed that from 
four to five hundred is the preferable size for an asylum, and that six 
hundred should never be exceeded. The asylums which are. working 
smoothly and well, with every care for the treatment of patiems, and 
effective supervision, are, as a rule, below this number; and" "for eco- 
nomical reasons, from four to five or six hundred is the preferable number. 
The maintenance rate generally increases where the population is below 
or above it." 



151 



Table, 



Giving a List of certain American and European Asylums, with the Amount 
of Land about them and the Amount used for Pleasure Grounds {Airing 
Courts included). 

[Manning's Report.] 



ASYLUM. 



Acres of 
Land. 



Pleasure 
Ground. 



Worcester County. 

Sussex County. 

Essex County 

Three Counties 

Ne w Surrey 

Middlesex County (Colney Hatch) 

Gloucester County 

Derby County 

Lancashire County 

Leicester County 

Stafford County (New) 

Stafford County (Old) 

Lincoln Coun ty 

Bristol Borough 

Cotton Hill Lunatic Hospital 

Northampton Hospital 

Retreat, York 

Elgin District Hospital 

Perth Hospital > 

Haddington Hospital 

Fife Hospital 

Montrose Royal 

Government Asylum, Washington. 

Pennsylvania State 

Northampton (Mass.) State 

New Jersey State 

New York 

Evreux, Departement Eure 

Quatre Mares, Departement 

Seine Inferieure 

Sainte Anne, Departement Seine..... 
Yille Evrard, Departement Seine.... 

Yancluse, Departement Seine 

Colony of Fitz James, at Clermont 

Meerenberg, Holland 

Guislain's Asylum, Ghent 

Hamburg 

Illenau 

Frankfort 

Gottingen 



100 

200 

96 

252 

150 

150 

80 

100 

96 

80 

100 

77 

40 

32 

80 

75 

30 

92 

60 

12 

57 

110 

230 

130 

200 

120 

200 

150 

100 

14 

750 
700 
1000 
70 
35 
65 
42 
40 
20 



20 
30 
10 
20 

80 
10 
50 
25 
15 

17 

10 
14 
10 
15 
28 
12 

2 

7 

30 

105 

18 

4d 

60 
60 



20 
15 
20 
12 
10 



152 



Table, 



Showing Number of Patients and Assistants in certain Asylums, with the Sala- 
ries of the Superintendents in certain of the English arid Scotch Asylums. 

[From Manning's Report.] 



ASYLUM. 



3 

p 
o 


o 
o 

•is 


Salary 
interi 


hi 

B 

co 


co 

CO 

CO 
rt- 

pa 

co 


of Super- 


206 
342 






1 




391 


1 


£500 


469 


1 




502 


1 


650 


510 


1 


550 


534 


1 


550 


540 


1 


600 


554 


1 


800 


590 


2 


500 


650 


1 


600 


836 


2 


600 


962 


2 


750 


1,124 


2 




2,026 


2 


600 


220 


1 


350 


213 


1 


300 


380 


1 


400 



ASYLUM. 




3 
O 

o 



Bristol 

Derby 

Leicester 

Stafford 

Lincoln 

Sussex 

Three Counties 

Worcester 

Essex 

Gloucester 

New Surrey 

Lancashire, Lancaster 
Lancashire, Prestwich 

York, West Riding 

Colney Hatch 

Perth District 

Cupar 

Montrose 



Quatre Mares 

St. Yon 

St. Anne 

Ville Evrard 

Evreux 

Guislain's Asy., Ghent 

Meerenberg 

Hamburg 

Frankfort 

Gottingen 

Illenau 

Washington 

New Jersey State 

Pennsylvania State.... 

Northampton 

New York State 



715 
950 
600 
600 
500 
450 
600 
350 
200 
300 
450 
380 
500 
380 
420 
608 



CONSTRUCTION. 

To make the lunatic as much " at home " as possible, to make the 
household arrangements of an asylum resemble those of a large private 
dwelling house so far as is consistent with salubrity of structure, economy 
of expenditure, and facility of supervision and management, should be 
the leading principle in the construction and internal arrangements of 
asylums. 

Asylum construction must depend somewhat on the classification of 
the patients which is considered necessary. 

The classification recommended is: 

1. Recent cases. 

2. Sick and infirm. 

3. Violent and noisy. 

4. Ordinary patients. 

In an asylum for five hundred patients, at least six divisions for each 
sex are necessary; and in this case the "ordinary" patients may be 
placed in two divisions; but with a smaller number, three or four will 



153 

suffice; the "recent" and "ordinary" cases being amalgamated or not. 
Thirty to forty patients are a sufficient average number for each division. 

For a small asylum the maximum population of which is never to 
exceed two hundred, the modified cottage plan is the one to be most 
recommended. 

For an asylum built originally for one hundred and fifty or two hun- 
dred patients, but intended for enlargement, so as eventually to contain 
four hundred, the " house " plan or the pavilion plan are most fitted for 
the original structure. 

For an asylum built originally to contain five hundred patients in six 
divisions, the pavilion or block plan may be mainly adopted and supple- 
mented by cottages; or plans may be so modified as to embrace the 
house, pavilion, and cottage plan, blended into one harmonious whole, as 
in the New Surrey Asylum.* 

If the three plans are combined to form one asylum the two classes 
who require most constant care and attention (the sick and the acute 
cases recently admitted) should be placed in the part built on the 
"house" plan, which will be under one roof with the administrative 
department, and so within easy access of the Eesident Physician. 

The ordinary patients and the violent class may be placed in detached 
blocks, two or three in number for each sex; and the small asylum town 
thus built be supplemented by cottages for idiotic and convalescent 
patients. 

The cottage plan is particularly fitted for patients of good education. 
It adds vastly to their comfort to se23arate them from the other inmates. 
For convalescent patients also, the association with sane people is very 
beneficial, and they by this means are allowed greater liberty, and are 
able to resume gradually their accustomed life, instead of passing at 
once from the asylum ward and its artificial existence to the realities of 
actual life abroad. 

The special block for violent and noisy patients, which should be the 
smallest division of the house, should have connected with it and open- 
ing from it, a one-storied building, capable of containing four or five 
patients. It should consist of corridor and single rooms, and should 
have one or more small airing courts, opening either from the corridor 
or the rooms. 

The question as regards the number of stories in an asylum must 
depend chiefly on the uses to which the rooms on the ground floor are 
applied. If the ground floor is to be divided into day room and dining 
rooms, and so the patients occupy only half of it at once, the numler 
for which it will serve will not be greater than can be contained in one 
dormitory floor; but if the dining room accommodation is provided else- 
where, the space for sitting or day room accommodation will be doubled, 
and made sufficient for the number of patients who can be accommodated 
in two stories built over it. The space required for sitting and day 
room in asylums is reckoned to be about half that required for the 
night. 

The material to be selected for asylum construction may fairly be that 
which is most readily procurable, so long as it is durable and not porous. 
So long as the windows are of large size, the particular style may fairly 
be left to the architect entrusted with the planning of the building. 

A full supply of pure water is an important requisite in an asylum, 

i £ 

* See Appendix F, plates 5, 6, 7. 
20 



154 

and no site should be chosen where this cannot be obtained. If the 
asylum be near the town, the town supply will be found cheaper and 
altogether more convenient than any other arrangement; but when at a 
distance, the supply from a well or spring, especially if this is close to 
the buildings, is the best method, since the steam engine which will 
always be necessary to pump and fill tanks, may be made to serve other 
purposes also, as turning machinery, either at the laundry or farm build- 
ings, whilst the boilers which supply it may be used also for heating hot 
water for baths and lavatories, the kitchen and laundry. No supply 
from a running stream should be used without careful filtration, and if 
water- is procurable in any other way, surface drainage should not be 
resorted to, since, with this method in use, high farming is almost 
impossible, without running risk of dire illness to the inmates from 
animal poison contained in the water. The quantity required for the 
use of an asylum, even when earth closets are used, is not less than 
fifteen to twenty-five gallons per head per diem. 

For safety in case of fire, Dr. Manning says: "Keliance should be 
placed mainly on hydrants, for which proper hose should be kept always 
at hand, placed both outside in the grounds and inside on the staircases. 
These should be connected both with the ordinary water supply and 
with the tank; and where a steam engine exists, the pipes should be so 
arranged that the water may be played by steam power. Fire drill, at 
which attendants and patients should assist, should be practised at fixed 
intervals, and the hose and other appliances kept always in order. In 
asylums in which force of water sufficient to play the hose cannot be 
obtained, ordinary hand fire engines should be kept at the asylum, and 
the patent contrivance called ' L'Extincteur ' may be also kept at hand." 

Every asylum should be lighted throughout with gas, which is at 
once the safest, cheapest, and most effective mode of lighting. If gas 
cannot be conveniently obtained from a company's works, it may be 
made on the premises without difficulty, at a cost which will render it 
cheaper than any other kind of illumination such as it is necessary to 
have in an asylum. 

Dr. Manning gives it as his opinion that open fireplaces, especially 
when built with air-chambers, as in use in English asylums, form the 
best, simplest, and cheapest mode of warming asylums in a moderately 
cold climate; but in America the elaborate system of heating by steam, 
which has been almost universally adopted, is perhaps the best which 
could be used. 

Natural ventilation, with such accessories as may be deemed expe- 
dient — and the simpler these are the better — can alone be recommended 
for an asylum in a temperate climate. 

The height of twelve feet, proposed by the American Association of 
Medical Superintendents, seems ample for all the purposes of an asylum 
room. 

Every room should have its cubical contents painted on its door. 

In all asylums separate day and diningroom accommodation should 
be provided. It will be well that one diningroom should be provided 
for each sex, and that they should be placed on each side of the kitchen. 
Day room accommodation should be provided for each section of the 
asylum, at the minimum rate of five hundred cubic feet for each person. 
A general dining hall, or two dining halls — one for each sex — should be 
built conveniently situate with reference to the kitchen, capable of con- 
taining three fourths of the entire number of inmates. Experience has 



155 

shown in English asylums that this number may with safety and advan- 
tage be allowed to dine in common. 

Two airing courts for each sex are all that are absolutely necessary 
for an asylum. If a third is added for the use of the sick, infirm, and 
for special cases, such as epilepsy, it will be found frequently useful. It 
may save the more feeble among the patients from the accidents which 
might happen to them in the large general court. 

In every airing court there should be a sunshed and a verandah or 
covered walk, to afford shade and allow patients so inclined to take exer- 
cise in wet weather. 

The floorings of all the day and diningrooms and dormitories should 
be of wood. The boards should be tongued; and the English and Scotch 
Commissioners suggest that there should be a disconnection of the floor 
and joists at all internal doorways, by means of a stone sill. In ail 
cases where a fireproof construction is not adopted, similar separations, 
at not greater distances apart than fifty feet, should be made in the floor 
and ceiliugs. There is but little necessity for oiling or polishing the floor 
except in rooms devoted to dirty patients. 

The walls should be plastered or cemented, and subsequently painted 
or colored so as to make the rooms as cheerful and bright as possible. 

All rooms devoted to dirty patients should be whitewashed. 

The keys for the male and female side of the house should be different, 
and each attendant provided with one key which will unlock all the 
doors on his or her side of the house. A simple railway key will serve 
for each attendant to turn on or off water, gas, or to chock the window 
sashes, close or open shutters, etc., so that each attendant will have two 
keys only. 

Asylum stairs should be of stone or iron; the flights short and 
straight. Wooden or iron handrails should be provided for all stairs, 
and let into a groove in the wall. 

One kitchen, in a central position, is all that is required for an asylum, 
and in it, if properly arranged, all the food • for patients, officers, and 
attendants can be cooked. 

The laundry should be detached from the main buildings, and may be 
placed at some little distance, if water supply is thus made more easy. 

The arguments for a special chapel in connection with every asylum 
need not be repeated here. The best argument is the existence of such 
a chapel in the well ordered institutions of all countries. 

For minor amusements, the day rooms of the institution are sufficient, 
but a room where the majority of the inmates can be collected for 
dances, concerts, theatrical performances, gymnastics, lectures, etc., is 
absolutely necessary in an asylum. 

It is scarcely necessary to provide a special room for a library. 

The building for the reception of the dead should consist of two 
rooms at least. One of these should be the reception room, fitted with 
shelves for the dead, in which they may be seen by their friends. The 
other, a room for post mortem examinations, in which every convenience 
for the purpose should be supplied — a central table, hot and cold 
water, etc. 

It is desirable that the dead should be buried in the ordinary cemetery 
of the town or district. 

The balance of the report is devoted to "Organization," "Dietaries," 
forms for asylum reports, and architectural plans. 



156 



ORGANIZATION. 



A Board of Control should be appointed by the Government for each 
asylum, or for each district, and should consist of not less than five 
members, one or two of whom should be medical men, and the remainder 
men of high social standing, residing in the district in which the 
asylum is situated. The necessary expenses of the Board should be 
paid, and such remuneration made to the professional members as may 
be deemed fair, but the other members should not receive salaries, the 
position being entirely an honorary one. 

The members of the Board may either retain their seats permanently, 
or one or two members may retire annually, and be eligible for reap- 
pointment. 

The duties of the Board should be: 

1st. The control of the finances of the institution, and the preparation 
of the necessary estimates for, the consideration of the Government. 

2d. The appointment and dismissal of all officers, viz: Superintendent, 
Assistant Medical Officers, Secretary, Chaplain, and Housekeeper, sub- 
ject to the approval of the Government. 

3d. The visitation of the asylum and inquiry into its management and 
the general conduct of officers and attendants. 

4th. The inspection of the forms of admission sent with all patients, 
and the ordering of the discharge of all such as are recovered, or for 
whom their friends promise to make provision, one medical member of 
the Board being always present to examine the patient and affix his 
signature to the certificate of discharge. 

The Board should also be charged with the presentation of an annual 
report to the Government, in which the general and financial condition 
of the institution under its care is set forth. 

On the appointment of a Board of Control, asylum government will 
be thus divided: 

Superintendence and Management. 

The whole internal economy of the asylum will be under the conti ol of 
the Superintendent, and with him should rest the patronage, so far as 
the appointment of attendants and servants is concerned. 

Legislation. 

The making of all general laws for the conduct of the asylum, and for 
the guidance of all officers and attendants, will be the duty of the Gov- 
ernment. A general code of laws will serve for the government of all 
the asylums of the country; and all marked alteration in such laws 
should be made, or at least approved, by the General Government; 
whilst minor alterations, which are not contrary to their general spirit, 
may be made by the Superintendent or Board of Control. 

Financial Administration 

"Will be under the Board of Control, exact accounts of the financial con- 
dition of the asylum being submitted to the Government, with the esti- 
mates for each year. The estimates should include a sum for incidental 
expenses, to be spent at the discretion of the Board, and not exceeded. 
(The sum placed under the control of the Board is fixed, in the case of 



157 

the English county asylums and the State asylum, Broadmoor, at four 
hundred pounds for each year.) 

Patronage. 

The appointment of the Board of Control (and the Board of Inspec- 
tion, to be hereafter considered) will rest with the Government. The 
Board of Control will appoint all the officers, who are immediately re- 
sponsible to it, the Government approval being necessary to ratify the 
appointments. The Superintendent will appoint the attendants and ser- 
vants who come immediately under his directions. 

There remains to be considered the duties of 

* 
Inspection and Supervision. 

Doctor Manning then speaks of the way in which this is managed in 
the United States, Great Britain and Ireland, France, Belgium, and Hol- 
land, and then gives his opinion of what it should be in New South 
Wales : 

The duties of such a Board of Inspection should be: 

1st. The inspection of all asylums, public and private, at fixed periods 
not less than twice a year. At such inspection inquiry should be made 
as to their management; as to the regularity of admissions and dis- 
charges; the number of attendants; the dietary, and the general conduct 
of the institution. 

2d. The frequent inspection of the criminal asylum, which it is recom- 
mended in a subsequent part of this report should remain under the 
immediate control of the Government, without the intervention of a 
Board of Control. 

3d. (Is of local application, referring to the" Eeception House at Dar- 
linghurst.") 

4th. The examination of all criminal lunatics, either acquitted on the 
ground of insanity or found to be insane, in prison; and the direction as 
to their maintenance in the prison for observation, or their transfer to 
an ordinary or criminal asylum. 

5th. The transference of patients from one asylum to another for any 
reasons that may be considered good. 

6th. The registration, visitation, and official guardianship of all luna- 
tics under certificate residing with friends or with persons paid for their 
maintenance, with power of inquiry in all cases of detention and ill 
treatment by relatives of any insane person, whether under lunacy cer- 
tificate or not. 

7th. The examination of all certificates in lunacy, to see that they are 
in proper form and that all necessary particulars concerning the history, 
circumstances, social and mental condition of the patient are given. 

8th. Inquiry into all cases of complaints in asylums, and all cases in 
which the Lunacy Acts have been infringed. 

Superintendent. 

The Physician of every asylum should be Superintendent and chief 
executive officer of the establishment. He should have entire control of 
the medical, moral, and dietetic treatment of the patients; the power 
of appointment and discharge of all attendants and servants, and exer- 
cise a general supervision and direction of every department of the insti- 



158 

tution. He alone should be responsible to the governing body for the 
state and condition of every part of the institution, and he should be the 
recipient of all their orders. 

Assistant Medical Officers. 

The Assistant Medical Officers of asylums should be qualified medical 
practitioners, whose duty consists in assisting the Superintendent in the 
medical and general duties of his office, and representing him in his 
absence. 

Doctor Manning is of opinion that " the medical staff of an asylum 
containing acute and chronic cases in the usual proportion, should never 
consist of less than one to every two hundred and fifty patients; that 
whenever the asylum population exceeds two hundred and fifty, an 
Assistant Physician should be appointed; and that when the number of 
five hundred is reached, an additional assistant is necessary." 

COMMENTS UPON DOCTOR MANNING'S REPORT. 

We are of the opinion that no asylum should be without an Assistant 
Physician, and that an asylum of five hundred patients should be pro- 
vided with an additional assistant, as suggested by Doctor Manning. The 
Guislain Asylum, as well as many others in the Old World, are greatly 
at fault in this respect, and the bad effects of such policy are ever appa- 
rent. 

We have thus given a brief sketch of this exhaustive and admirable 
report, and can only again express a regret at our inability to obtain a 
copy for the State Library, and still hope an order sent to JSTew South 
Wales, through Messrs. Triibner & Co., No. 60 Paternoster Eow, London, 
may succeed in procuring one.* In most of the conclusions arrived at 
by Dr. Manning, as well as suggestions made to his Government, we 
heartily concur. But, as we cannot do so in all, we deem it due to our- 
self and what appears to be the interest of the insane in our midst to 
point out a few of the most important points of difference: 

1st. For reasons already stated elsewhere, we think that two hun- 
dred and fifty patients as large a number as can be treated in the best 
possible manner in one asylum, and that this number should never be 
extended beyond four hundred. We admit, however, that the practice 
of the present day is to build asylums for four hundred, five hundred, 
and six hundred patients, as he has suggested. 

2d. We are satisfied that the number of single rooms for one third of 
the patients is too small to insure the best results. His conclusions 
coincide with the custom in Great Britain and the continental countries, 
where one third is the greatest number provided with single rooms, even 
in the best asylums; whereas we agree with the custom in our own 
country, where the best asylums are never provided with single rooms 
for less than two thirds of their patients, and many of them a larger 
proportion. Under no circumstances should this be reduced to a less 
number than one half. We are fully aware of the advantages to be 
derived from the association of patients, but think this can be done 
to best advantage during the day, in large and pleasant airing courts, 
sitting rooms, and pleasure grounds. 

* Note. — Since the above was written the report of Doctor Manning has been received, 
and we recommend its perusal to the committees, Commissioners, and others especially 
interested in the subject. 



159 

3d. The recommendation for six divisions for each sex, in an asylum 
for five hundred patients, seems to be too small, and is two less than 
proposed by the Superintendents in the United States; eight divisions 
for either sex is a better number. 

4th. Dining halls for three fourths of the patients of either sex, one 
on each side of the kitchen, does not commend itself to our mind as the 
best method. The system in the United States of having each division 
take their meals in their own wards is preferred, as classification is best 
preserved. in this Way. Here we must also admit that in all the asylums 
in Great Britain and on the continent where we witnessed the patients 
of hospitals taking their meals in common dining halls, and often where 
males and females ate in the same room, no ineonvenier.ee or excitement 
was observed; but it must not be overlooked, that in all or nearly all of 
the instances referred to the patients were paupers, and the asylums 
almost exclusively occupied by them. This custom does not prevail in 
the asylums intended for the independent classes. In our country, all 
are accommodated in the same asylum, with very rare exceptions. The 
rich, the poor, the educated, and the ignorant, the refined and the vulgar, 
are all in one and the same institution, hence greater attention to classifi- 
cation and separation is an absolute necessity. 

Separate Asylum for Patients ivho Pay. . 

Some eminent men in all the countries we have visited have given as 
their decided opinion, that patients who pay and those who do not 
should never be kept in the same asylums nor placed under the same 
administration, as the privileges that will be allowed the one begets 
jealousies on the part of the other, while the necessities of a crowded 
asylum often enforces associations that would not be recognized at 
home, and with all the sensibilities sharpened by insanity, as sometimes 
happens, disgusts and dissatisfactions are engendered, and detrimental 
results the consequence. 

What is best to be done and what can be done are two very different 
propositions, and in a majority of cases we have to accept the latter. If 
it were possible, however, there is no question it would be best for each 
State to furnish one asylum for the accommodation of all of its citi- 
zens who desired to pay for accommodations superior to those that can 
be given to the indigent. These should be charged a sufficient sum' to 
defray all the expenses of such an establishment, including officers' fees, 
repairs/and other expenses, the State only furnishing the buildings. All 
other asylums should be free to every person belonging to the State who 
might elect to enter them, without the payment of fee of any kind. If 
this system could be adopted, many economical changes might be made 
in the construction of our asylums, without detriment to any class of 
patients. An asylum for one hundred pay patients would probably be 
sufficient for all of this class now in our asylum, or likely to be com- 
mitted during the next ten years. It should be as much under the con- 
trol and watchful supervision of State officers as the others, and all 
charges should be regulated by State authority, in order that no person 
should jDrofit by its operations save and except the patients who paid for 
the privilege of having more quiet, more comfort, and more attention 
than the State could afford to give. 

This idea, we fear, is in advance of American notions of propriety; 
yet believing it to be supported by sound policy, and with no injustice to 



160 

any, we hope to see it carried out in our State at some no distant period 
in the future.* 

5th. The common bath house on the ground floor, one for each sex, is 
another European custom adopted in nearly all asylums, many of which, 
admirable in all other respects, have not a single bath tub on the second 
or third floor. This is certainly a great defect, and must suggest many 
inconveniences to all who are acquainted with asylum management. We 
found in one asylum in Austria only one bath room for all the patients, 
the men using it one day and the women the next. One bath in four- 
teen days was all that could be obtained by each patient. This asylum 
was new, neat, comfortable, and well managed in all other respects, but 
the Medical Director could not prevail on his Board of Managers to 
supply even one other. We could but conclude that economy in this 
instance was a poor financier. 

6th. We cannot see any special advantage to accrue from a law requir- 
ing one of the Board of Control to sign certificates of discharge, as sug- 
gested by Doctor Manning. Surely the Superintendent must first say 
that the patient may be discharged without detriment ere the Trustee 
affixed his name; hence it would only seem an additional complication 
without corresponding benefit. Let us give the patient every protection 
and throw around him every necessary guard, but at the same time 
incumber our rules with no useless requirements. 

Wi'th these few differences with Doctor Manning, and some of them 
may be influenced by prejudice engendered by long habits of thought 
that observation has failed to remove, we most heartily indorse what he 
suggests, and commend his remarks to all readers. It has been our 
desire to present the ideas and opinions of others with quite as much 
freedom as our own, that our people may have the benefit derived from 
the experience of many observers. 

* Note. — Statement of the Number and Nativity of Pay Patients in the Insane Asylum 
of the State of California, January 1st, 1872. 



NATIVITY. 


Males. 


Females. 


Total. 




5 
4 
1 


1 
2 
3 
1 
1 
1 
1 


1 




6 




4 




1 






1 






1 


Chili 




1 




1 


1 


New Brunswick 


1 


1 










11 

8 


11 
3 


22 
11 






Totals 


19 


14 


33 







The foregoing table shows how small a proportion of the patients in our asylum pay for 
their support and treatment. There are a few others, no doubt, who would gladly avail 
themselves of asylum care and the benefits to be derived from the skill and experience of 
its medical officers, if proper accommodations could be offered them, but who shrink 
from the disadvantges and discomforts of the overcrowded wards of our asylum, and are 
thus kept at home till all hope of recovery is passed or the means of support have been 
exhausted, when they are sent to the asylum, to become life burdens upon the public 
Treasury. Until the system suggested can be carried out, we think it would be far better 
to abolish all charges, so far as they relate to citizens of the State. 



. 161 

It is scarcely necessary again to call attention to ventilation, warm- 
ing, lights, water closets, window guards, flooring, stairs, infirmaries, 
kitchens, laundries, chapels, dead nouses, amusement halls, theatres, 
dances, employes, attendants, airing courts, keys, etc., as we have done 
so to a sufficient extent in the sketch from Doctor Manning's report, and 
especially as we must necessarily touch upon some of them in speaking 
of the character of asylums which we think best adapted to the nature 
of our climate and the characteristics of our people. 



CHAPTEK XI. 
CRIMINAL INSANE. 



Another question connected with the care of the insane should not be 
passed by without notice. In England, Scotland, Ireland, and some of 
the continental countries, and in New York, in this country, asylums 
have been erected for keeping the criminal insane separate from the 
others, and strong arguments have been advanced in favor of the uni- 
versal adoption of this system. These have been divided into two classes: 

1st. Those who have been convicted of crime, and become insane while 
serving out their sentence of punishment. 

2d. Those who have committed criminal acts during their insanity. 

We can see no good reason why those of the latter class should be 
deprived of treatment in an ordinary asylum. In the eyes of the law 
they have really been acquitted of any criminal intent, and cannot be 
punished; nor should they be disgraced by being confined in an asylum 
with those whose crimes have led them to insanity. 

With the first, or convict class, the case is entirely different. Though 
they have become insane, and are thereby entitled to every consideration 
of sympathy, and every effort at restoration, they have not been cured of 
their immoral ideas, low cunning, gross vulgarity, and vicious habits. 
On the contrary, these are often whetted by insanity, and exhibited in 
an intensified degree. They have no power to conceal the real hideous- 
ness of their character, nor restrain the debased vulgarity of their nature. 
They are not only unfit associates for the unfortunate people who occupy 
the wards of an asylum, but have a detrimental influence upon their 
recovery. 

But this whole subject has been so ably and forcibly argued in the 
report of the Worcester Hospital, we cannot better bring the matter to 
the favorable notice of the Legislature than by quoting from its pages : 

FROM THE WORCESTER REPORT, 1862. 

Criminal Insane. 

The experience of nearly thirty years operation of this hospital, and 
the careful observation of the successive Boards of Trustees, of the 
Superintendents, and others engaged in the management of this institu- 
tion, all go to establish and to strengthen their conviction that it is 
impolitic and wrong to place insane criminals in the same rooms, wards, 

21 , 



162 

or even establishments with the honest and untainted patients, and 
require them to live together. 

No one will assert that the prison is a proper place for a lunatic ; and 
it is equally clear that the hospital, created for and occupied by patients 
from general society, is not a proper place for a criminal. Admitting 
that the insane convict should be removed from the one, it by no means 
follows that he should be carried to the other. Whether viewed in the 
light of humanity or of economy, it is better that he be detained in his 
prison than be admitted into the hospital, for, at the worst, if he be not 
removed, he may remain insane for life for want of the means of heal- 
ing, while if he be placed in a ward filled with other and respectable 
patients, he maybe an obstacle to their restoration, and prevent some, 
perhaps many, from 8ver regaining their health. The question is not 
simply whether the insane convict shall or shall not have an opportu- 
nity of being healed, but whether an attempt shall be made to save a 
criminal and worthless citizen, by the peril and perhaps the sacrifice of 
the restoration of some, possibly many, honest and valuable men who 
must live and associate with him in the hospital. 

Insanity disturbs the mental health of its victims in various ways. 
Among the most common of these morbid conditions, is the exaltation of 
sensibility, which makes the patients timid, anxious, suspicious, irrita- 
ble, and even sometimes quarrelsome. Some are depressed in spirits, 
and almost crushed with a sense of imaginary sinfulness, or an intense 
consciousness of un worthiness. To meet these morbid conditions of the 
patient, the hospital Managers endeavor to bring the most favorable 
influences to act upon him; they surround him with everything sooth- 
ing, gentle, and acceptable. They provide everything to cheer, encour- 
age, and elevate him, and inspire him with confidence that his new 
position in the hospital is all for his good. They arrange all the circum- 
stances, select his associates, and control the conversation; they deter- 
mine the scenes that may be visited and the ideas that may be presented, 
according to their influence on the over sensitive and disordered mind. 

It is among the best established principles of the treatment of insanity, 
that a patient should be opposed or interfered with as little as possible, 
consistently with his good; that his notions and arguments should not 
be disputed, his wishes and inclinations indulged, so far as they can be 
safely, his opinions and tastes treated with respect, when they are 
proper, but always with tenderness, and that everything should be done 
to encourage his self respect. 

Among the patients in the hospital fere always the members of our 
own families — our parents, our brothers and sisters, our sons and 
daughters. From their childhood they have been taught to love virtue 
and abhor vice, to avoid even the appearance of wickedness, to associate 
with good and shun evil company. They have been accustomed to run 
from the base, the degraded, and the corrupt. Their sensibilities, their 
tastes, and their consciences have been cultivated and shaped in accord- 
ance with their education and their habits. They lose none of these in 
their disease. Insanity tends to exalt and intensify them. They become 
morbidly sensitive, and even irritable, in respect to them. 

To put a convict among such patients as these, to compel them to 
associate with him in the same halls, to eat at the same table, to hear 
his coarse and offensive conversation, his vulgar slang, his profanity, 
his curses at religion and honesty and religious and honest men, his 
contemptuous jeers at what they have been taught to regard with rev- 
erence, his tales of cunning and crime, of successful and unsuccessful 



163 

villainy — all this is in contravention of the best principles of managing 
mental disorders, and diminishes if it does not counteract the influence 
of the curative measures that may be used. 

It is at least a singular view of*governmental responsibility that, look- 
ing for the highest good of the community and the moral and spiritual 
welfare of all its members, educates children and youth to walk in the 
ways of holiness, and encourages all of every age to associate only with 
the pure and the upright, when they are well and able to choose for 
themselves, but gives them felons for familiar companions when they 
are broken down with mental disease and too weak to choose their 
company. 

The hospital is provided for all the families of the commonweath. In 
the chances of life any one of us may be exposed to the accidents or 
influences that cause insanity, as well as to those that cause fever. Any 
of our children may be afflicted with disease of the brain, as well as 
with disease of the lungs. 

A daughter, the idol of her parents, becomes insane. Her anxious and 
almost agonized friends take her to the hospital and leave her there, 
in confidence that her intensely sharpened sensibilities will be soothed 
by the gentlest associates, the tenderest language and most refined man- 
ners of those that surround her; but she is shocked to find in the same 
hall with her, perhaps sitting next to her at table, a convict from the 
House of Correction, a woman that had previously been the keeper of a 
brothel, and still retains her vulgar obscenity and her lascivious ways. 
Or a son, trained in the same way, may become deranged on the subject 
of religion. Self chastening and downcast, he enters the ward and finds 
among the inmates a burglar from the State Prison, who has been edu- 
cated and practiced in all manner of wickedness, and takes a pleasure in 
the display of his own corruption and in offending the sensibilities of 
such as he considers to be over nice and fastidious. 

Among the insane there are always some whose recovery is doubtful, 
whose chances of mental life or death hang like a balance so evenly 
adjusted that the slightest weight will turn the scale, the least disturb- 
ing cause will decide the issue against them. These are watched by the 
officers and attendants in the hospitals with the tenderest solicitude, and 
guarded with anxious vigilance to protect them from every unfavorable 
influence. To such as these, standing on the verge of mental death, the 
presence and companionship of a felon from the prison may be sufficient 
to overthrow them and determine the fatal course of their disease. 

These are cogent reasons, strongly put, and must carry conviction to 
the mind of every man as to their propriety and justice. The convict 
insane in California are not sufficiently numerous, however, to justify 
the establishment of a separate asylum for their accommodation, but it 
would be an easy matter to erect a suitable building in conjunction with 
the hospital at San Quentin, to be devoted to this class of patients. The 
hospital physician could give them the needful medical attention, and 
they would cost no more to take care of them there than at Stockton, 
where there is no suitable place to keep or retain them, to say nothing 
of the cost of transportation. 



164 



CHAPTEE XII. 
CHKONIC Jj^SANE. 
Provisions for Curables and Incurables in Separate Institutions. 
v SEPARATION. 

This is a question that has excited some attention in all countries. 
And though it has been practicably decided as unwise and improper by 
the Association of Medical Superintendents of American Institutions for 
the Insane, and most of the bodies of a similar character in other coun- 
tries, still it finds individual advocates in some of them. In Italy it is 
by no means uncommon, while in Austria and some of the German States 
it is rather the rule than the exception. It was one of the subjects to 
which we directed especial attention in our inquiries, and the opinions of 
every Superintendent with whom we met during our investigations was 
solicited. About one fourth of those in Italy, one half in Austria, 
Moravia, Bohemia, Saxony, and a few other of the German States, per- 
haps a tenth in other continental countries, and one in twenty of those 
in Great Britain and the United States, were in favor of separation, 
while all the rest were opposed to the principle and the practice. 
Economy seemed to be the leading argument of those who favored its 
adoption, though a few placed it upon higher grounds, and contended 
that while the chronic and incurable cashes were quite as well cared for, 
and could be better employed, and allowed more liberties than in a cura- 
tive establishment, that their removal increased the chances of recovery 
in the more recent cases; while another class seemed to favor the erec- 
tion of different buildings for the two classes in proximity to each other, 
and under the same administration, in order that transfers might be 
made from the one to the other, as might in the judgment of the Super- 
intendent be deemed expedient. 

On the other hand, it is contended that all such institutions are more 
liable to degenerate into negligence, inattention, and decay; that they 
are cruel to the patients who are thus told of their hopeless condition 
and must therefore spend the rest of their days within asylum walls; 
that instead of being a disadvantage to the more recent and curable cases, 
the reverse of this is actually the case; that by their habits of obedience 
and order, others submitted more readily and cheerfully to the rules and 
requirements of the institution ; and that by their example and willing- 
ness to labor and to take part in other occupations and amusements, the 
acute cases more readily joined in these necessary and healthful pur- 
suits; with many other arguments familiar to all who have paid any 
attention to the subject, and which might be introduced here if deemed 
of the least importance. Candor compels us to say that our observations 
of the results of the two systems forces us to the conclusion that sepa- 
ration is wrong in principle and detrimental to the best interest of the 
insane. While this is decidedly our opinion, however, we most cheer- 
fully admit that some of the asylums for the chronic insane were 
admirably managed in every respect, and their Superintendents intelli- 
gent, zealous, and attentive men, devoting their whole time and all of 
their energies to the unfortunate patients under their charge; and that 
this is true of some of these institutions in all the countries we visited. 
That atjOvid, on Lake Seneca, in the State of New York, with its 



165 

splendid location and beautiful and picturesque surroundings, especially 
impressed us most favorably, and was such a paradise in comparison to 
the miserable wards of the poorhouses from which they had been taken 
that we cannot but regard its establishment as a boon to the insane poor 
of the State. We failed to discover, however, even the shadow of a 
reason why a person becoming insane in the neighborhood of this beau- 
tiful asylum should be sent to Utica because he was considered curable, 
and that one in Utica should be sent to Ovid because the reverse of this 
was true. It would seem infinitely better that each asylum should 
admit all of either class occurring in their respective vicinities. They 
should be as successfully treated at the one asylum as the other; while 
it is too plain a proposition to require argument that economy of trans- 
portation and convenience to family and friends would be best subserved 
by keeping them at the asylum .nearest their homes. 

With regard to the results of treatment, the facts elicted arc altogether 
in favor of non-separation; the percentage of cures being less and that of 
deaths greatest in those countries where the system of separation is most 
generally pursued. 



CHAPTEE XIII. 
TKEATMENT OF INSANITY. 



Treatment in English Asylums — Mania — Epilepsy connected with Insanity — Paralysis 
connected with Insanity — Melancholia — Observations on present Treatment of Insanity. 

TREATMENT IN ENGLISH ASYLUMS. 

In the further report (1847) of the Commissioners in Lunacy for Eng- 
land and Wales will be found a circular letter, addressed to the proprie- 
tors or Superintendents of Asylums, containing several questions in 
reference to their methods of treating cases of insanity, and the disor- 
ders complicated with it. 

These questions referred especially to the treatment adopted: 

First — In mania. 

Secondly — In epilepsy connected with insanity. 

Thirdly — Paralysis connected with insanitv. 

Fourthly — In melancholia. 

Replies were received from fifty-three physicians in charge of these 
establishments, from which we extract the following as a fair specimen 
of the whole, as elucidating the most approved methods of treatment 
adopted at that time by the most learned men of the day. 

MANIA. 

First — in regard to Mania : 

The Practice pursued at the Devon County Asylum, as described by Doctor 

Bucknill. 

With hot scalp, full pulse, etc., from six to twelve leeches to the tem- 
ples or behind the ears; the head shaved, and evaporating lotions applied; 
a warm bath for half an hour at bedtime; the bowels open, by one dose 



166 

of calomel and jalap, followed, if necessary, by salts and senna; then one 
fourth or one third of a grain of tartar emetic in solution, every three 
or four hours. The patient is not kept upon low diet; he is clothed 
warmly, and in the open air as much as possible, and the opportunity of 
muscular exertion and fatigue is allowed. If he does not sleep, two 
drachms of tincture of henbane, with camphor mixed, are given at bed- 
time; if this does not succeed, one drachm of laudanum, with one drachm 
of sulphuric aether, are given when the acute symptoms have yielded. 

When the head is cool, the face pale, the pulse compressible, I give 
warm baths, with aether and ammonia, and sometimes aether and lauda- 
num, or Hoffman's anodyne, with aloetic aperients. When these symp- 
toms are accompanied by great unsomnolence or restlessness, with illu- 
sions, and when I can ascertain that the patient has been a drunkard, I 
give wine, aether, and large quantities of opium, the indications of treat- 
ment being the same as in delirium. 

When the patient, with the ordinary symptoms of mania, presents 
those of typhus fever, with sordes on the teeth, picking the bedclothes, 
etc., 1 give warm negus, frequently ammonia, camphor, aether, with occa- 
sional doses of calomel. I have fortunately never lost a patient suffering 
under acute mania. 

Remarks. 

General bloodletting I never use, and cannot, therefore, give an opinion 
upon. 

Local Bloodletting 

I use frequently, by leeches, to the groin, temples, or neck; or by cupping 
the nape of the neck. In inflammatory diseases within the chest, I find 
that free cupping between the shoulders, followed by the use of anti- 
mony or mercurials, is sufficient, and that bleeding is not required. 

Emetics 

I have given, with benefit, where exacerbation of melancholy is accom- 
panied by foetid breath, or discharge of gluey mucous from the stomach; 
also in incipient dementia with lethargy and indigestion, and for chronic 
cough. 

Purgatives. 

Patients are often admitted with obstinate constipation, and for them 
the stronger purgatives are necessary; but afterwards, this condition is 
not allowed to prevail, and an occasional, or, if need be, a small daily 
dose of compound rhubard pill, or castor oil, or decoction of aloes, or 
house medicine, is all that is requisite. Five or six grains of calomel are 
given when the state of the liver requires it, but I have now discontinued 
the use of drastic purgatives. I have used them with decided benefit in 
maniacal cases, but have made up my mind that antimonials are more 
manageable and safe. The house medicine above mentioned is made of 
the sulphate of magnesia and soda, with senna, and extract of liquorice, 
decocted, and peppermint water added, when cool; the patients like it, 
and a dose, to produce two or three dejections, will often cut short be- 
ginning excitement. 



167 

Antimonials. 

1 use tartar emetic frequently in acute and recurrent mania, dissolving 
three or four grains in mint water, with simple syrup, and giving one 
twelfth part every three, or four, or six hours. After a few doses the 
medicine does not usually produce sickness, the appetite is not dimin- 
ished, and the patient often gains flesh during its use. Two or three 
gamboge colored evacuations are generally passed in the day. I believe 
that this medicine acts less by its depressing agency than by some influ- 
ence upon the congested capillaries of the brain, enabling them to con- 
tract. I find that repeated doses of ipecacuana, though more nauseat- 
ing, are not equally useful. • 

Opiates and Anodynes 

I use sparingly. In the cases before referred to as resembling delirium 
tremens, oj^ium is given in large quantities. It is not given if there is 
heat of the scalp and a strong pulse. In other cases of sleeplessness, 
where it is not thus contra-indicated, it is usually combined with sul- 
phuric ether, or with camphor. Hyoscyamus, in combination with ammo- 
nia and camphor, is often given as a sleeping potion, but sleep is more 
frequently induced by warm baths, cooling lotions to the head, or some 
food in the middle of the night, than by means of narcotics. A plaster 
of extract of belladonna is sometimes used to the epigastrium or peri- 
cardium as an anodyne. Other narcotics have been tried without encour- 
aging results. 

Antispasmodics. 

The compound galbanum pill and mixture, containing the foetid spirits 
of ammonia or the tincture of assafoetida, are sometimes given to females 
with uterine derangement; but tbe only antispasmodic in frequent use is 
the spirits of turpentine, given to epileptics with a view of reducing the 
number and the severity of the fits. 

Iconics. 

Vegetable bitters, with ammonia and aromatic stimulants, or with 
mineral acids, or with liquor potassae, or with small doses of iodide of 
potassium, are frequently used; also, chalybeates, in the form of steel 
wine or compound steel pills, or iodide of iron dissolved in simple syrup, 
which prevents its decomposition, are given in numerous cases with ben- 
efit. The only tonic not in general use which has been given is the sul- 
phate of strychnia, in doses from the thirtieth of a grain upwards. It 
is never given to produce nervous twitchings. It requires occasional 
doses of aloetic medicines, and is useful in some cases of melancholia in 
old people. 

Stimulants 

Are frequently used medicinally. Those preferred are aether and ammo- 
nia, strong beer, porter, and wine. They are mostly given to patient 3 
who are admitted in a reduced condition, or to those whose strength is 
failing from general decay, paralysis, or other cause. 



168 

Bathing. 

Tepid, warm, shower, and vapor baths are used. A tepid bath is given 
to all the patients once a week in Summer and once a fortnight in 
Winter, for the sake of cleanliness. Warm baths are constantly used to 
allay excitement and to induce sleep. Shower baths are used as a tonic 
to dyspeptic and hysterical young patients, but not to old ones. They 
are also sometimes given to the refractory as a penal remedy. Vapor 
Jbaths have been tried upon some old persons suffering from melancholy, 
with dry and harsh skin, it is thought with benefit, but further experi- 
ence is required. 

Practice pursued at Middlesex (or Hanwell) County Asylum, as described by 

Doctor Conolly. 

A kind and soothing reception, immediate removal of restraints, a warm 
bath, clean clothing, comfortable food, encouraging words, a medical 
treatment first directed to any manifest bodily disease which may 
occasion the cerebral disturbance, as of the uterus, stomach, etc., or the 
general loss of strength; and if such disease or debility is not manifest, 
attempts to allay the irritation of the brain more directly by leeches 
occasionally applied to the head, gentle aperients, moderate doses of 
tartarized antimony, sometimes combined with sedatives, cold applica- 
tions to the head, blisters behind the neck, shaving the head, and friction 
of the scalp with the tartarized antimony, the warm bath, or in violent 
cases the cold shower bath efficiently .applied; tranquility, occasional 
exercise in the open air, exercise and occupation in chronic cases, clean- 
liness, order, good diet, attention to relieve heat and thirst, particularly 
in the night, a careful avoidance of everything that can irritate the 
brain, including the avoidance of the strait waistcoat, etc. Antimony 
and all sedatives are of uncertain effect, and sometimes of none, time 
seeming alone to effect a cure, provided proper and constant care be 
taken of the patient. 

General Remarks. 

It will be observed that I consider the direct treatment of any form of 
insanity by mere medicinal application to be very limited; but the indi- 
rect treatment of mental maladies by innumerable means acting upon 
the body and mind of immeasurable importance. These means can, I 
believe, seldom be efficiently applied, except in well constructed and 
well conducted asylums, superintended by well educated men, aided by 
benevolent and active attendants. By such means I believe many insane 
persons to be capable of cure, and all, however incurable and hojDeless, 
capable of improvement and relief. 

I will merely add, that I am convinced that general bloodletting is 
rarely admissible, and generally dangerous in insanity, and that local 
bleeding by leeches is safe and serviceable in most cases. I have no 
faith in emetics. I think purgatives are often needlessly employed. 
Antimony is often of temporary service; sedatives, though occasionally 
most efficacious, are also most uncertain in their effects. The acetate of 
morphia, the hyoscyamus, and the cannabis indica, have appeared to me 
to be the most frequently useful. Tonics and stimulants are frequently 
of service, and every form of bathing in different instances. I have 
ceased to employ the douche bath, as it occasions more distress to the 






• 169 

patient than the shower bath or than cold affusion, without correspond- 
ing benefit. 

A liberal diet, moderate use of malt liquor, exercise out of doors, 
employment, recreation, mental occupation, friendly intercourse, and 
judicious religious attentions, are all important auxiliaries to amend- 
ment. 

Practice in the Surrey County Asylum, as described by Sir Alexander Morison. 

If the patient is brought under mechanical restraint, this is removed 
and the warm bath is generally employed. The hair, if considerable, is 
thinned, and in some cases removed; and recourse is had to laxative 
medicines, as jalap, rhubarb, senna, calomel, sulphate of magnesia, cro- 
ton oil, castor oil. Nauseating medicines are sometimes given to allay 
excitement — in particular, small doses of tartrate of antimony; also 
sedatives, as hyoscyamus, morphia, camphor, nitre. Cooling lotions are 
applied to the head. Topical bloodletting by cupping or by leeches 
(general bloodletting has not been employed). Blisters to the nape of 
the neck. Animal food daily. Porter or wine have in some cases been 
given. . Few recent cases of mania have been received, owing to the 
vicinity of the public hospitals of Bethlem and St Luke's. 

Practice pursued at Stafford County Lunatic Asylum, as described by 

Mr. James Wilkes. 

In the medical treatment of the cases of mania sent to this Asylum 
the first indication is sought in the careful examination of the patients' 
general condition, in ascertaining how far the cerebral excitement 
depends upon increased vascular action, and in detecting the nature 
of any bodily disorder that may be present. Although the latter is 
often obscure, still some derangement of the thoracic or abdominal 
organs, either functional or organic, is a constant complication of mania, 
and remedies directed to their relief are often sufficient to cure the men- 
tal disorder. 

In many instances the patient when brought to the asylum is in so 
prostrate a condition*, either from exhaustion, produced by the disorder 
itself, from having refused food, or from the extent to which bleeding, 
purgatives, and low diet have been carried, that the course of treatment 
is at once clear, and good nourishing diet, stimulants, and tonics often 
restore the patient, unless, as is too frequently the case, the symptoms 
of sinking have already set in. 

The injurious effect of active medical treatment in cases of mania, and 
the tendency there is to exhaustion and sinking is so fully established 
that the general practice in this asylum is chiefly directed to supporting 
the vital powers, subduing the cerebral irritation, and correcting the 
existing physical derangement, not by any peculiar or specific mode of 
treatment, but upon ordinary principles. 

In pure cases of mania, however great the excitement may be, general 
bleeding is never employed. The cerebral irritation is often materially 
relieved and every advantage gained by local bleeding, without mate- 
rially depressing the patient's strength. For this purpose, leeches to the 
temples or behind the ears, and cupping on the same parts or on the 
nape of the neck, are the means usually employed, due regard being had 

22 



170 

in using these to the amount of vascular action and condition of the 
patient. 

Any obvious derangement in the patient's general health, or in the 
function of any particular organ, is attended to, and appropriate reme- 
dies prescribed; *but the usually defective state of the digestive and 
assimilative organs renders attention to them of much importance. The 
bowels, when torpid, are freely acted upon, and if there is nothing to 
contra-indicate such a course, the morbid and accumulated secretions are 
removed by a dose or two of calomel, either alone or combined with colo- 
cynth; and if the patient refuses medicine, croton oil and ehemata are 
employed. If there is much exhaustion, an enema alone is prescribed. 

The various narcotics and sedatives are constantly used in this asylum 
in the treatment of cases of mania, both acute and chronic, and though 
they are uncertain, and no very precise rule can be laid down for their 
employment, they are, on the whole, found to be highly serviceable. 
They appear to be of the most benefit in cases attended with great ner- 
vous excitement, and are of little use and often positively injurious when 
there is much febrile disturbance, especially in typhoid symptoms or vas- 
cular determination to the head. The description of narcotics to be used, 
and also the dose, can only be determined by experience in individual 
cases. The free action of the bowels should be previously obtained, and 
then either solid opium, the tincture, Battley's sedative solution, or mor- 
phia, are prescribed, combined in some cases with antimony or ipecacu- 
ana, hyoscyamus, camphor, or aether. In cases of great excitement 
any of these, in small doses, rather increase it, and it is important to 
prescribe it in full doses and frequently to keep up the narcotic action 
by repeating it every four or six hours. The Indian hemp has latterly 
been used here, and, when genuine, is a valuable and powerful remedy. 
In several cases in which I have employed it the excitement has been 
subdued and sleep obtained, when large and repeated doses of opium and 
morphia only added to the restlessness of the patient. Its after effects 
also seem to be less injurious than those of opium; constipation is not 
produced, and the constitutional disturbance is often relieved. 

When there is much febrile disturbance, with heat of skin and thirst, 
the saline mixture (composed of liq. amnionise, acet. vin. antimon., pot. 
tart., tinct. hyoscyami, potassae nitras, and mixtura camphorse) is fre- 
quently prescribed with good effect, the action of the skin being pro- 
moted by it and the restlessness relieved. 

In certain cases of acute mania, and also in the chronic form, the 
employment of tonics is found to be of much use, especially in enfeebled 
constitutions with weak pulse and depressed vital powers. Quinine, 
iron, and the vegetable bitters, combined with stimulants and aromatics, 
are prescribed in these cases. 

The exitement in mania is rather increased than relieved by low diet, 
and the usual difficulty is to get the patients to take sufficient food. The 
diet used here is ample and nutritious, and the principle of supporting 
the patient's strength and making up for the waste and exhaustion which 
are going on in the system, by an abundant supply of nutriment, is here 
fully acted upon. 

Thus, patients who are laboring under much excitement are not 
restricted to the ordinary dietary, bufr are supplied with meat daily, 
soup, milk, eggs, sago, arrow root, etc., and often with wine, brandy, 
ale, and other stimulants; and daily experience proves that in many 
chronic cases life may be prolonged by a liberal diet, and that in recent 



171 

cases it alone often cures the patient and even supersedes medical treat- 
ment. 

The use of the warm and shower bath is found here to be of much 
importance in the treatment of mania. The warm bath seems to exert 
a sedative influence in many cases of excitement, and may generally be 
employed in safety. The tepid or cold shower bath, when cautiously 
employed, is also a powerful means of subduing the paroxysm, and many 
patients acknowledge that it alone has cured them. It seems to be of 
the greatest benefit in cases of mania attended with heat of scalp and 
increased vascular action, and when unattended with much general dis- 
turbance of the system or symptoms of thoracic or abdominal disorder. 
In the latter complications the use of the shower bath is at once contra 
indicated, and the warm bath may be substituted for it. 

Cold lotions, ice, and cold affusion to the head are constantly employed 
whenever heat of scalp, suffused eyes, and increased arterial action indi- 
cate fullness of the cerebral vessels. 

In acute cases of mania, blisters are not often used here, as they serve 
to add to the excitement by the irritation they produce. In cases of 
chronic mania they are employed, and especially when there is evidence 
of slow mischief going on in the brain. 

Remarks. 

Emetics. — These, as directed to the treatment of insanity, are never 
employed in this asylum, nor are the depressing doses of tartarized anti- 
mony which some practioners recommend. In cases of gastric or biliary 
derangement, in which emetics would be indicated under other circum- 
stances, they are occasionally employed. 

To the observations on general bleeding I may add that not only is 
there a want of proof of relief having been obtained by this popular 
remedy in any of the cases brought to this asylum in which it has been 
practiced, but its injurious effects have been so repeatedly and decidedly 
witnessed, either in producing fatal exhaustion or reducing the patients 
to a hopeless state of imbecility, that in cases of simple mania, uncom- 
bined with inflammation, its adoption cannot be too strongly deprecated. 

In reference to the diet of the insane, daily observation increases my 
conviction that a liberal supply of good, nutritious food both adds to the 
recoveries and diminishes the mortality in institutions for the insane, 
being an important means of cure in recent cases and of prolonging life 
in the chronic and incurable. 

Practice pursued at Brislington House, as described by Doctors F. and C. Fox. 

In cases of mania, which, we must observe, seldom come under our 
notice in the incipient stage, we have rarely seen benefit derived from 
general bleeding. Small quantities of blood are often abstracted by the 
cupping glasses from the nape of the neck; the bowels are evacuated 
freely by aloetics combined with nauseating doses of tartar emetic taken 
each night, and succeeded by castor oil in the morning. The cold plunge 
or shower bath is usually taken each morning, and it is repeated with 
much advantage in the evening in cases of sleeplessness. In the more 
protracted cases of mania, the principal medical treatment has consisted 
of counterirritants to the scalp or to the pit of the stomach, with atten- 
tion to the state of the skin and bowels, the maintenance of a warm at- 



172 

mosphere in the sleeping apartments, a plain and nutritions diet, and the 
use of much exercise, unattended with violent bodily exercise. 

Remarks. 

We have found it impossible to comprise under either of the foregoing 
heads a large proportion of the cases which have been in this asylum, or 
to describe any uniform mode of treatment as applicable to the cases in 
either of the divisions. In those cases of moral perversion which occur 
without the existence of any delusion, we have seen much benefit de- 
rived from the system adopted in an asylum. In this form of insanity 
we have generally discovered a propensity to excess in diet and to 
intoxication, or to the indulgence of lascivious habits; and we have 
found a spare diet, cold bathing, saline purgatives, early rising, and 
active exercise, with a prolonged separation from the scenes and habits 
of former excitement, most useful to such patients. We believe that 
such a system can be enforced only in an asylum, and that moral treat- 
ment and the services of a chaplain are of much importance in these 
cases. 

General bloodletting is only resorted to by us in those cases of mania 
in which the physical condition of the patient induces the apprehension 
of apoplexy, and never for the purpose of quieting a paroxysm of 
excitement. Previously to admission, most of our patients have been 
under medical treatment, and we have often had reason to suspect that 
the general bloodletting to which they have been subjected has been 
detrimental, and that it has in some cases induced permanent fatuity. 
We have found general bleeding useful in some cases of melancholia. 
In most forms of insanity, we find benefit derived by the local abstrac- 
tion of blood from the head or nape of the neck; in some cases, by the 
application of leeches to the pit of the stomach, and in females, to the 
groin. 

We value antimonials in the treatment of insanity much less for their 
emetic action than the change which they effect in the circulation, and 
we find that this object is gained by nauseating doses, which tend to 
allay maniacal excitement and to procure sleep. 

We consider that the use of purgatives is indicated in almost all 
forms of insanity in the incipient stages, and we find them especially 
useful in melancholia, until they can be dispensed with by attention to 
diet and exercise. Opiates and anodynes have frequently been resorted 
to by us, with a hope of success which has but rarely attended their 
use. In paralysis and epilepsy we have derived benefit from the use of 
antispasmodics, tonics, and stimulants, and in some cases of melancholia 
dependent upon uterine disturbance, but we have not found these reme- 
dies in the treatment of mania. 

We attach much value to the use of hot and cold bathing. In mania, 
we chiefly use the cold plunging and cold shower bath, and we find the 
warm bath and the cold shower bath, with the feet of the patient 
immersed in hot water, more applicable in cases of melancholia. 

We are of opinion that maniacal and melancholic patients almost 
invariably require a generous and nutritious diet; this we find to be 
equally necessary in cases of chronic insanity. In epilepsy and paral- 
ysis, connected with insanity, we often find it necessary to place the 
patients upon a very restricted system of diet. 



173 

EPILEPSY IN CONNECTION WITH INSANITY. 

Secondly — in regard to epilepsy, we quote: 

Remedies used in Cases of Epilepsy at Devon County Asylum, as described 

by Dr. Bucknill. 

The patients are placed on a wholesome and nutritious diet and 
regimen. Indigestion is treated by tonics and other appropriate reme- 
dies; costiveness is removed by small daily doses of co. rhubarb pills, 
decoct, of aloes, castor oil, or house medicine; when the fits are severe, 
one drachm of spt. of turpentine, with mx. of liq. of potass, every four 
hours; sinapism to the legs and feet, and three or four ounces of blood 
from the neck by cupping. 

Turpentine undoubtedly diminishes the strength and frequency of the 
fits, and I have only seen it once produce bloody urine. In young 
patients, the frequent application of croton oil to the scalp, and the long 
continued use of mercurial alteratives (hycl. chloria. is preferred) have 
apparently effected cures. 

Remedies used in Cases of Epilepsy at the Middlesex (or HanwelV) Asylum, 

by Doctor Conolly. 

Cases of epilepsy being generally associated with occasional mania, 
are treated on the principles before mentioned. In the fit, care is taken 
that the patient sustains no injury. Epileptics should sleep on low beds 
or cribs, or beds on the floor. In the excited or maniacal state nothing 
is done to irritate the patient. When restraints were resorted to the 
epileptics were often furious, and generally dangerous; since their dis- 
use, the epileptic ward has become the quietest in the asylum. . I have 
never seen a case of epilepsy in an adult permanently cured by any 
medicine whatever. Attention to the general health, the occasional 
application of leeches to the head, blisters behind the neck, and, in some 
cases, an incision in the scalp, have served to lessen the cerebral conges- 
tion. Setons appear to me to be useless, as well as issues, and all other 
modes of severe counter-irritation. 

Remedies used in Cases of Epilepsy at the Surrey County Lunatic Asylum, by 

Sir A. Morison, M. D. 

Many cases of this description have been admitted. In them attention 
is given to the general health by remedies tending to improve the state 
of the digestive organs. 

Leeches, in» some cases, have been of service; also, rubefacients, coun- 
ter-irritants, and blisters, and tartrate of antimony, externally applied. 

Preparations of silver and turpentine have been given internally, but 
with little good effect. 

Organic mischief, to a greater or less extent, has been found in the 
brain in all the cases of epilepsy, connected with insanity, which have 
been examined in this asylum. 

Remedies used in Cases of Epilepsy at the Stafford County Asylum, by Mr. 

Wilkes. 

The cases of epilepsy usually sent to this asylum are usually connected 
with congenital defect, or are of such long standing and so intense in 



174 

degree that any hope of cure or material relief is out of the question ; 
and the only indication seems to be, to attend to the patient's general 
health, and guard against and relieve cerebral congestion. In cases of 
obvious debility the employment of tonics is of use, especially those of 
the mineral class, as the preparations of iron, zinc and the nitrate of 
silver. The excessive state of congestion which frequently occurs is 
here treated by the free exhibition of purgatives, as large doses of calo- 
mel and croton oil; the application of leeches or cupping to the temples; 
ice, cold lotions, and cold affusions to the head, blisters to the nape of 
the neck, stimulating pediluvia and enemata, especially those containing 
turpentine and assafcetida. While the diet should be nourishing, it 
should not be stimulating; and the disposition to over-nutrition should 
be carefully guarded against. As a general rule, the free action of the 
bowels is kept up by the frequent exhibition of purgatives. 

Remedies used in Cases of Epilepsy, at Brislington House, by Doctors F. and 

C. Fox. 

If such cases are of recent date, we have sometimes seen good results 
from the use of nitrate of silver, with small doses of turpentine; an 
incision on the scalp, leeches on the perinseum, the tepid shower bath, 
much friction of the skin, as much pedestrian exercise as the patient can 
accomplish, and a restricted vegetable diet, have often been useful. By 
paying close attention to the periodical tendency which this disease so 
frequently displays, and by meeting the gradual increase of nervous 
irritability by a small local bleeding and a moderate anodyne, we have 
sometimes succeeded in prolonging the intervals between the attacks, 
and on some occasions in effecting a cure. 

PARALYSIS CONNECTED WITH INSANITY. 

Thirdly — In regard to paralysis, we quote: 

Remedies used in Cases of Paralysis at Devon County Asylum, by Doctor 

Bucknill. 

When the patients are not admitted in a bedridden and ulcerated con- 
dition, good diet and regimen generally improve the strength, and the 
progress of the disease appears to be very slow. A few leeches are 
sometimes applied to the temples, when the face is apt to flush and the 
scalp to become heated. Having observed that some patients who had 
sore legs appeared to be more comfortable when the suppuration was 
free, I have tried setons, but cannot as yet give an opinipn about their 
utility. In sinking cases, wine and porter are freely given, and slough- 
ing sores are dressed with equal parts of tinct. of kino and liq. of subace- 
tate of lead, and a yeast cataplasm is applied for three or four hours 
every second day. 

Remedies used in Cases of Paralysis at the Middlesex (or Hanwell) County 

Asylum, by Doctor Conolly. 

The paralytic complication (paralysie generale of the French) makes 
great care necessary to prevent injury to the patient. Good food, porter, 
occasional tonics, and in all cases warmth and comfort, evidently prolong 
life for many years. The patients neither bear reduction nor excite- 



175 

ment; even baths are scarcely to be recommended. Leeches and aperi- 
ents are sometimes required to lessen congestion in the head. Small 
doses of calomel and squills have occasionally seemed useful, but I am 
satisfied that all specific modes of treating this form of paralysis are 
ineffectual as regards a cure. Many of the miseries of the malady, as 
uncleanliness, ulceration, and fits of violent anger, are prevented or long 
retarded by kind treatment and the absence of all bodily restraint. 

Remedies used in. Cases of Paralysis at the Surrey County Asylum, by Sir 

Alexander Morison, M. D. 

The same may be said as to the existence of organic mischief in cases 
of this description, of which a large number have been examined. The 
remedies employed have been laxatives, leeches, blisters, generous diet, 
and tonics, especially quinine. In most cases recourse has been had 
to water beds on account of the extensive ulceration which frequently 
attends the termination of these unfortunate cases. 

Remedies used in Cases of Paralysis at the Stafford County Asylum, by Mr 

Wilkes. 

Cases of paralysis connected with insanity, like those of epilepsy, are 
rarely sent to this asylum before the disease is in an advanced stage, and 
as far as my experience goes, the patient in a hoj)eless and incurable state. 
Life, in many cases, is prolonged by care and attention, and it is especially 
needful to guard against congestion of the brain, and so to regulate the 
diet as not to encourage undue nutrition and plethora, which is often at- 
tended with serious aggravation of the symptoms. The occasional exhi- 
bition of purgatives, and even those of an active character, are necessary 
to relieve congestion, and the tendency, which usually exists, to consti- 
pation. Local bleeding, by means of leeches and cupping, to the temples, 
behind the ears, or nape of the neck, is also employed, together with 
blisters and other counter-irritation, especially when there are symptoms 
of coma. The iodide of iron and a mild mercurial course, combined in 
some cases with tonics, have been tried in this asylum, but without per- 
manent benefit; the organic changes in the brain, upon which the disease 
depends, appearing to be beyond the influence of medical treatment. 

Remedies used in Cases of Paralysis at Brislington House, by Doctors F. and 

V. Fox. 

We have arrested this disease by the use of iodide of mercury, by the 
prolonged application of open blisters to the parietal junction of the scalp, 
and by the use of the electro-galvanic apparatus to the affected portions 
of the body. 

As such cases have generally occurred in aged or wasted constitu- 
tions we have often had recourse to chalybeate medicines, but have 
experienced their injurious effects upon the mental disease. These cases 
are rarely presented to our notice- in a curable state. 



176 

MELANCHOLIA. 

Fourthly — in regard to melancholia, we quote : 

Remedies used in Cases of Melancholia in the Devon County Asylum, by 

Doctor Bucknill. 

I endeavor to appreciate and to treat the bodily condition wherever it 
is disordered. In young women with suppression of the menses, I order 
leeches to the vulva, hip baths, aloetic aperients, and often chalybeates. 
In elder women, at the critical period, an occasional blue pill, a small 
daily dose of decoction of aloes, vegetable tonics, sometimes galbanum, 
or assafcetida, or chalybeates. In various cases with dyspepsia, I have 
given bitter infusions with mineral acids or alkali, or gr. iij. doses of 
iodide of potassium with liq. potassae or lime water. 

In some cases emetics have been very beneficial, and shower baths are 
good tonics and safe in the Summer months. When pain, sense of burn- 
ing, etc. is felt in the head, I have given blue pill to twitch the gums, 
and used counter-irritation to the scalp. When the skin is dry, warm 
bath with friction, or vapor baths are used. I have found the electro- 
galvanic apparatus beneficial in some cases, when used moderately so as 
not to produce fear or pain. 

Remedies used in Cases of Melancholia, at Middlesex {or HanwelV) Asylum, 

by Dr. Conolly. 

The attention is first directed to any manifest bodily disorder, or to 
existing debility or plethora, often with the effect of curing the patient. 
Leeches behind the ears or to the forehead, blisters behind the neck, 
small and sometimes large doses of sedatives, give relief in some cases. 
The warm bath is soothing; and, in some instances, the shower bath has 
great effect. Occupation of mind and body, cheerful and encouraging 
conversation, and the absence of all restraints or apparatus calculated to 
alarm the patient, are of great importance; direct attempts to stimulate 
the faculties, by various impressions, by frequent change of scene, or by 
wine or spirituous liquors, are seldom successful, and sometimes very 
hurtful. Tonics are, in some cases, serviceable, as calumba, cascarilla, 
or preparations of iron. When plethora is manifestly present, daily 
saline aperients are generally useful. 

Remedies used in Cases of Melancholia in the Surrey County Asylum, by Sir 

Alexander Morison, M. D. 

Few recent cases of this description have been sent to this asylum, 
owing to the cause stated in regard to recent cases of mania. 

Laxatives, sedatives, tonics, warm baths, shower baths, and blisters, 
have been chiefly employed. 

The most numerous cases are those of dementia, in a more or less 
advanced stage. The object in them has been to improve the general 
health. Warm baths, shower baths, and blisters, have been occasionally 
employed. 

In all cases where practicable, recourse is had to occupation, useful or 
agreeable. As little restraint is employed as is deemed to be consistent 



177 

with the safety of the patient and of others, and this is continued for as 
short a time as possible. 

Remedies used in Cases of Melancholia at Stafford County Asylum, by Mr. 

James Wilkes. 

This state is generally found .to be connected with a low condition of 
health and a depressed state of the vital powers, independent of direct 
symptoms of cerebral disorder, and the medical treatment followed in 
this asylum is chiefly directed to restore the functions of any organ 
which may seem to be impaired, and to invigorate the patient's general 
health. The frequent association of melancholia with various forms of 
dyspepsia and disorders of the assimilative organs is not overlooked; 
neither are the defective quality and quantity of the urine, and the 
changes which so often take place in its chemical composition. 

The employment of purgatives is rarely to be dispensed with, and 
these are often required in large and repeated doses to obviate the ten- 
dency to constipation which usually exists. The various combinations 
of tonics and stimulants with purgatives are here advantageously used, 
as the bitter infusions with sulphate of magnesia, and compound spirits 
of ammonia, aloes, quinine, and iron, in the form of pills, with sulphate 
of iron; alterative doses of calomel, or blue pill, are also given when 
the functions of the liver are disordered. When there is headache and 
symptoms of fullness in the head, the application of leeches is of service; 
and much benefit is often derived in cases of melancholia from the regu- 
lar use of the shower bath whenever there is no obvious reason for not 
applying it. 

Sedatives and narcotics in various forms are used in this asylum with 
great benefit, the restlessness of patients being subdued by them and the 
nervous system tranquilized. The preparation of opium (especially 
Battley's sedative solution), morphia, Indian hemp, hyoscyamus, conium, 
camphor, lactucarium, in different combinations, are given with the best 
effect. The diet in cases of melancholia requires regulating in reference 
to the state of the digestive organs, but should always be nutritious, 
and in many cases may be advantageously combined with stimulants. 

Remedies used in cases of Melancholia at Brislington House, by Doctors 

F. and C. Fox. 

In melancholia which has succeeded to an attack of mania we have 
so often found that the disorder has again reverted to the maniacal form, 
that we generally confine the medical treatment to moderate evacuations- 
of the patient's bowels, with regulation of the diet, and we encourage 
that increased indication to quiet and to sleep which such cases usually 
exhibit. Melancholia, as an idiopathic disease, is the only form of insan- 
ity in which general bleeding has appeared to us to be useful. In such 
cases we often open the vena saphaena, prescribe warm and aloetic pur- 
gatives, counter-irritation to the region of the stomach, warm bathing, 
carriage and horse exercise, and animal diet. 

TREATMENT AT THE PRESENT DAY. 

The foregoing extracts show the most approved treatment of insanity 
23 



178 

as practiced in the English asylums twenty-five years ago. In many 
respects it is essentially the same at the present time. A few of the 
remedies then employed have been laid' aside, or are regarded with less 
favor now, while a few others have been discovered or brought more 
prominently to notice, and have been substituted for them or given in 
conjunction with them. 

General Bleeding. 

General bloodletting was not approved by any of the authorities we 
have quoted, though we see that the practice was spoken of as one too 
much in vogue, and as detrimental in the extreme. Such is the uni- 
versal opinion of the physicians at this time, and in no instance nor in 
any form of insanity was it recommended by those with whom we met 
as a proper remedy to be employed. 

Local Bleeding, 

Local bleeding, by cups or leeches, is still practiced by some physi- 
cians, and regarded with as much favor as ever, while it is rarely 
resorted to by others, and therefore not so generally emjDloyed. 

Counter-irritants. 

Shaving the scalp, blisters, and counter-irritants, including setons, are 
also less employed than formerly, while tartar emetic and digitalis have 
become extremely unpopular with many, and are now cautiously and 
sparingly used by all. 

Baths. 

Baths in all forms seem to be less used in England than formerly, and 
in the asylums of the United States have a less prominent place than 
they deserve, while in Italy, the German States, and in some portions of 
France and Holland they are relied on as of paramount importance. 
Indeed, they seem to be the chief agents employed in some of these 
countries, and are administered in one way or other in nearly all forms 
and phases of the disorder. The shower bath, the douche, the plunge, 
and continued bath, are all supposed to have their peculiar virtues as 
stimulants, tonics, or sedatives, and are used ad libitum et ad infinitum. 
We have often seen half a dozen patients in one bathroom, each with 
the head only visible, the body being immersed in warm water, and the 
bathtub covered with a lid having a hole in one end to fit around the 
neck. Here they usually remain from one to three hours; in some cases 
six to eight hours, and in occasional instances for days at a time. Doctor 
Gudden of the Asylum at Zurich, in Switzerland, informed us that he 
had on one occasion kept a man thus confined in a bath five days. In 
this instance there was a high state of excitement connected with bed- 
sores; and the treatment was for the double purpose of allaying the one 
and relieving the other. The patient is represented as having slept well 
during a portion of the time spent in the bathtub, while the bed-sores 
were entirely healed. The most remarkable feature in this case was the 
entire freedom from exhaustion or any other evil consequence. We 
would have supposed that such relaxation of the physical powers would 
have ensued as to have rendered resuscitation impossible. We were 
also informed that in a case at Yienna, where a man had been scalded by 



179 

steam, Doctor Hebra had him placed in a tepid bath and kept there for a 
period of three weeks, "an til a new cuticle had formed over the entire 
body. The patient recovered without inconvenience. This case was 
not one of insanity, and has been introduced to show how much endu- 
rance is possessed by some persons under peculiar circumstances, and to 
direct attention to this treatment. The water, of course, was kept of 
uniform temperature, and at such degree as was most agreeable to the 
patient. The agonizing pain usually attendant upon scalds is said to 
have been effectually overcome. In most of the asylums in these coun- 
tries there is a general bathroom for either sex, and in many of them, 
especially Santa Maria della Pieta at Borne, and St. Ann at Paris, are 
fitted up in the most elaborate manner. In addition to the ordinary 
appliances for the warm and vapor bath, the douche, plunge, and shower 
bath, there are the Turkish and medicated baths, and a peculiar contri- 
vance made with metallic pipes an inch in diameter, forming circles like 
the hoops of a barrel. These tubes are perforated with innumerable 
holes on the inner side, so as to send small streams of water under heavy 
pressure upon every inch of the body at the same time. This the poor 
fellow has to submit to till the doctor or master of the bath concludes 
that the object sought to be accomplished has been attained. It seemed 
to us a frightful ordeal through which to pass, and from the contortions 
and grimaces of the patients we infer it was regarded in the same unfa- 
vorable light by them. 

At the Asylum San Ton, at Eouen, presided over by Doctor Morel, 
a writer well known to the scientific world, a man of ability, and a wor- 
thy successor of Esquirol and other celebrated men who had charge 
of this famous old asylum in bygone days, we also found them both 
much employed, and especially in the treatment of epilepsy. The 
shower bath is used twice a day in these cases, after Avhich the patient 
is wraj)ped in a sheet. He reports one case of great violence entirely 
cured by this method, in which bro. pot. and other remedies usually 
resorted to had signally failed. He had also seen great benefit in other 
cases, and entertained the opinion that no remedy equalled it with which 
he was acquainted. 

There can be no question about the efficacy of baths in the treatment 
of insanity, when judiciously prescribed and proj)erly administered, but 
like all other powerful agents they are liable to abuses, by which they 
are brought into disfavor. Doctor Blanche, of Paris, and Doctor Skae, 
of Edinburgh, informed us that after many years of persistent and suc- 
cessful use of the warm bath in the treatment of acute mania, they had 
been induced to abandon it entirely, for notwithstanding the happy 
effects derived from it in most cases, they had become convinced that 
several patients for whom they had prescribed the warm bath had died 
in consequence of its depressing influence. 

We conclude, therefore, that baths, like most other valuable agents, 
are too much used in some countries and too little in others. No remedy 
is so general in its effects as to be applicable to all cases, and its failure 
to accomplish all that may be expected of it is no reason why it should 
be totally abandoned. Chloroform and opium are sometimes fatal when 
administered in ordinary doses, yet they are # too valuable to be aban- 
doned on this account. Let us use all the remedies of value that science 
has given to our profession, but let us watch their effects and administer 
them with prudence. 



180 

Purgatives. 

With regard to purgatives, no change seems to have taken place for 
many years. They are regarded as absolutely necessary in certain con- 
ditions in all phases of insanity, the particular kind to be einjDloyed 
being a mere matter of taste with the physician prescribing them. Those 
employed twenty-five years ago are as much in vogue to-day as they 
were then. 

Emetics. 

Emetics are even less popular now than formerly, and are not often 
administered. Indeed, what we have said of tartarized antimony in its 
sedative and other capacities may also be said of it as an emetic. None 
of the emetics are popular remedies at this time. 

Anodynes, Narcotics, etc. 

Anodynes and narcotics, which have occupied such a high place in 
the confidence of most medical men who have been engaged in the treat- 
ment of insanity during the last quarter of a century, are now being 
subjected to earnest criticism by some, and almost angry, if not unrea- 
sonable, opposition by others. They are remedies used in some form, 
though in various degree, by nearly all the Superintendents of asylums 
with whom we have met, regardless of country or differences of opinion 
on other subjects. Hence, we might naturally expect to find that they 
have been misused in some, and greatly abused in other instances. Dr. 
Maudsley, the President of the Psychological Association of Great 
Britain, in an able and interesting address, read before that association 
August third, eighteen hundred and seventy-one, made narcotics the 
subject of special notice, and deprecated their use, in most cases, in 
decided terms, denominating them the " chemical restraint," that had 
been substituted for the mechanical restraint of former times. It was, 
perhaps, natural that this class of remedies should have been used to 
excess in a country where public opinion had been so much excited by 
and had waged such vigorous war against the employment of mechan- 
ical restraint — even in its mildest forms — in any asylum in the realm. 
In almost every asylum of ordinary size, there are a few patients who 
at times become so much excited, and have such irresistible propensities 
to injure themselves or others — to tear their clothing, indecently to 
expose their persons, or commit other equally unreasonable acts — that it 
becomes absolutely necessary to restrain them by some means — mechan- 
ically, if you choose, by seclusion in padded rooms; by the muscular 
power of attendants, or by narcotics, anodynes, etc., the " chemical re- 
straint" of which Dr. Maudsley now complains. Mechanical restraint 
being tabooed by public opinion, was not to be thought of ten or twenty 
years ago. It would have cost any Superintendent in England his official 
head to have undertaken it, and let the fact be known. Seclusion, when 
long continued, is attended with many evil results — loss of appetite, 
depression of spirits, the engendering of filthy habits, or other effects 
detrimental to physical health and mental integrity. Attendants, unfor- 
tunately, are not always tdessed with that amount of sweetness of temper, 
of untiring patience, and unlimited self-control, that will enable them, 
either through a sense of duty or from Christian principles, when " struck 
upon one cheek to turn the other," even though the offender be a lunatic. 
Hence the necessity, in England, more than in other countries, of resort- 



181 

ing to sedatives and other chemical restraints to produce the quietness 
and relief that could not otherwise be attained. The debate that fol- 
lowed the reading of Doctor Maudsley's address revealed the fact that 
all did not agree in the views he had expressed; but, on the contrary, 
many stoutly maintained that anodynes were among the most valuable 
agents employed in the treatment of insanity; while all admitted that 
cases did occur in which it was necessary to employ them in some form. 
In such a discussion, it was natural to inquire which of the many neu- 
rotic medicines was best calculated to accomplish the desired end with 
least injury to the patient. Opium, morphine, Battley's sedative, hyos- 
ciamus, cannabis indicus, bromide of potash, chloral hydrate, and, in some 
instances, a mixture of two or more of these drugs, was given prefer- 
ence. But the most remarkable and varied views were entertained with 
regard to the effects and efficacy of the hydro-chloral. It is thought, 
by Doctor Phys Williams and a few others, to be of little consequence 
either one way or the other. Doctor Browne, of Wakefield, has rej)orted 
three cases of death from it in the asylum under his care — two of these 
having occurred the same day, and within half an hour after taking 
thirty grains of chloral. While Doctor Clouston, of the Cumberland 
and Westmoreland Asylum, near Carlisle, and many others, have admin- 
istered it in large doses with no dangerous symptoms, but the best results. 
It is used with more or less freedom in very nearly all the asylums of 
Italy, Austria, the German States, Switzerland, and Holland; but very 
rarely in France and Belgium. Doctor Lehman, of Pirna, in Saxony, 
gives it in doses of from thirty to one hundred and twenty grains; 
Doctor Koeppe, of Halle, in doses of forty-five to one hundred and thirty- 
five grains; Doctor Guentz, of Thonberg, near Leipzig, gives from forty- 
five to seventy-five grains; and Doctor Ludwig, of Heppenheim, admin- 
isters from thirty to ninety grains, repeating the dose three times a day; 
while Doctor Leiderdorf, of Doblins, near Vienna, expresses the opinion 
that chloral hydrate will supersede all other remedies as a quieting agent. 
Dr. Professor Neri, of Perugia, Dr. Serafino Biffi, of Milan, Dr. Poller, 
of Illenau, and others, have also used it, and express the highest opin- 
ion of it as a quieting, sleep-producing agent. Dr. Poller thinks, when 
long continued, it has a tendency to produce congestion of the skin; 
while Dr. Lehman thinks it has a tendency, under similar conditions, to 
produce stranguary; but as he also gives very large doses of cannabis in- 
dicus, it may possibly have been confounded with the effects of that drug. 
In the asylums of the United States it has been more or less employed 
for the last two years, and the testimony in its favor has been very gen- 
eral. But few:, if any, of the Superintendents claim for it curative prop- 
erties, while nearly all regard it as one of the best hypnotics known to 
the profession. We must conclude, therefore, from all the testimony we 
have been able to collect from various sources, that chloral hydrate is 
not only one of the most innocent but one of the best remedies that can 
be used in .most cases where sleep alone is the object desired. We know 
that it, like most other remedies of its class, will fail to produce like effects 
upon all persons; and it may be so much adulterated as to be either 
worthless or dangerous; and in no other way can we account for the 
varied results observed by the English Superintendents. We have 
spoken more especially of this remedy because less is known of it by the 
general reader than almost any other of equal importance. We prefer 
to administer it in twenty grain doses, given at bedtime, and repeated 
every hour till sleep is produced; and never to give it, or any other 
remedy of its class, except when the end to be accomplished is esteemed 



182 

an absolute necessity. Of this necessity the physician must be the judge 
in each case as it presents itself. If chemical restraint seemed to be the 
proper remedy, we would use it. If mechanical restraint should seem 
of more importance in any given case, we should not hesitate to employ 
that instead of the other; nor can we see any good reason why the 
physician should be left with unlimited power to use the more dangerous 
remedy, while the other is entirely prohibited. The camisole or muff is 
the only kind of mechanical restraint that should ever be emj)loyed 
under any circumstances, except for surgical reasons, and these only by 
the order and in the presence of the physician. In these views we are 
confident that two thirds of the Superintendents in Great Britain will 
heartily concur, and at least nine tenths of those in other countries, in- 
cluding our own. In truth, we are disposed to believe that mechanical 
restraint is too freely used in most of the asylums in our country as well 
as on the continent; and in this respect we go quite as far wrong in one 
direction as they do in England in the other. 

Dr. Morel, of St. Yon, is one of the warmest advocates of the non- 
restraint system with whom we met in all France. He had paid a visit 
to Dr. Conolly, at Hanwell, where he had seen its practical operations 
under the eye of the master, of whom he was an ardent admirer. 
Having imbibed Dr. Conolly's views, he made to his Government one of 
the ablest reports on the subject that we have read, and so thoroughly 
was he convinced of the j)ropriety and practicability of the system that 
he at once put it in practice in the asylum over which he presided, nor 
did he abandon it, even in surgical cases, until a deformity in a case of 
fracture of the leg demonstrated the absurdity of treating lunatics and 
those possessed of their reason alike in all cases. Had this patient 
been strapped to the bed during the process of union, this calamity 
would have been avoided, and so it may be said of others of like char- 
acter. Hence, Dr. Morel now thinks the use of the camisole as necessary 
in rare instances as any other remedy intrusted to the judgment and 
discretion of the physician, nor does he hesitate to prescribe its use 
when he thinks the patient will be benefited, but under no circum- 
stances does he permit an attendant to employ it without his direction. 
The chemical restraint, opium, morphine, chloral, etc., are prescribed by 
the physician only, and so should it ever be with mechanical restraint, 
the camisole. . 

Epilepsy. 

We have seen that the remedies employed in this fearful disease were 
principally the metallic salts — nitrate of silver, oxide of zinc, citrate of 
iron, bichloride of mercury, etc., assisted by setons, blisters, cups, pur- 
gatives, and antispasmodics — and that all were equally unavailing. 
The disease is still considered incurable by almost all who have been 
called upon to treat it, though it is now claimed by a few that in rare 
cases among the young, and especially in those cases where insanity 
supervenes on a previously existing epilepsy, it is not necessarily incu- 
rable, and that, in a large majority of cases, the frequency and severity 
of the attacks may be lessened, thus modifying the disease and amelio- 
rating the unhappy condition of the patient. We have already stated the 
treatment by shower bath pursued by Doctor Morel, at San Yon, and 
given the results. Similar claims have been made by different persons 
in favor of each of the remedies above enumerated. Thus, Doctor 
Deiderdorf, of Dobling, near Vienna, reports one case, cured with ox. 
zinc; another, when there was a syphilitic taint, with iod. pot. Doctor 



183 

Fischel, of the Koyal Bohemian Asylum at Prague, attributes the cure 
in one case to Fowler's solution; and so on through the entire list. But 
the remedy most used in the present day, and that in which there is 
most confidence, is unquestionably the bromide of potassium. It is given 
by nine tenths of the profession who have charge of asylums; and while 
but few ascribe to it curative powers, most of them claim that it greatly 
ameliorates the attacks, and often wards them off entirely during its 
administration, thus giving its victims long intervals of relief and repose, 
while in a few instances complete restoration is effected. It is given in 
doses varying from five to one hundred and twenty grains, according to 
the urgency of the case and the peculiar views of the physician. ISTor 
is its employment confined alone to the treatment of epilepsy. Some 
use it in the treatment of nymphomania and kindred affections, while it 
is the only neurotic medicine employed by Doctor Blanche in his asy- 
lum at Passy. He gives fifteen or twenty grains three times a day as a 
quieting agent. It is often administered in combination with other seda- 
tives, anodynes, or narcotics — and is thought to increase their efficiency, 
and is one of the few remedies that have attained almost universal popu- 
larity. 

Paralysis. 

In the treatment of this disease as connected with insanity but little 
change has taken place within a quarter of a century, unless, we should 
say, it is not so much treated as formerly. Blisters, the galvanic bat- 
tery, counter-irritation of all kinds, and the shower bath, seem to be less 
used than formerly; while the only new remedy employed, so far as we 
know, is the ergot of rye, as prescribed by Doctor Chrichton Browne, 
of the Wakefield Asylum in England. He thinks good effects have been 
accomplished by its use, but sufficient time has not yet elapsed to test its 
efficacy. 

MORAL TREATMENT. 

The moral treatment of insanity is considered of more importance by 
many persons having charge of the insane than the medical, and the 
tendency to this opinion seems to be gradually increasing. It compre- 
hends all of those means which operate on the feelings and habits of the 
patient, and exerts a salutary influence by tending to restore them to a 
natural and healthy condition. The means to be employed under this 
head are as varied as the diseases leading to or the symptoms developed 
by insanity. It is in the judicious employment of the remedies of this 
class that the physician and the attendants are called upon to use the 
greatest skill and tact of which they are capable, whether as connected 
with individual cases or collective numbers. One important particular 
belonging to moral treatment has been already alluded to in our remarks 
on the non-restraint system. The English Commissioners in Lunacy say: 

" There is nothing more important in the moral treatment of the 
insane than the proper use of means which contribute to their employ- 
ment, both mental and bodily, and tend to withdraw their attention from 
thoughts and feelings connected with their disordered state." 

The provision made for the attainment of these objects in our asylums 
cannot be too strongly recommended, nor insisted upon with too much 
pertinacity by those whose duty it is to watch over them. 

Employment in agricultural labor, in the vegetable garden, among the 



184 

vines and fruit trees, or in cultivating flowers for their amusement and 
entertainment, will be of the greatest advantage to all of the insane who 
can be induced, either by persuasion or slight compensation, to partici- 
pate in them. The general health will be improved by this exercise 
in the open air, the appetite increased, the nervous system is less easily 
disturbed, the mind more composed, sleep is sweeter, sounder, and more 
refreshing, and the patient, with less opportunity to brood over his 
disease or imagined troubles and wrongs, gravitates naturally and by 
degrees into old habits of thought, health, and cheerfulness; the equi- 
librium is restored, and the patient is well. 

Single Booms. 

Another matter coming under the head of moral treatment or manage- 
ment may be properly mentioned here. It is the general opinion, 
expressed in words and carried out in practice, that all excited patients 
should be kept by themselves in single rooms, or cells, as they are unfor- 
tunately called throughout Europe; and especially, that they should be 
so kept at night. Doctor Morel is decidedly of the opposite opinion, 
and while he admits their necessity in a few isolated cases, has demon- 
strated to his own satisfaction that the theory is wrong and the practice 
injudicious in most instances. He has, therefore, taken out the partition 
walls between most of these cells and converted them into dormitories, 
and assured us that where four noisy, restless, sleepless patients were 
formely kept in single rooms, sixteen were now passing quiet nights, 
sleeping well, and giving every evidence of being better satisfied. He 
argues that most of the excited, noisy patients are afraid to be left alone 
at night, and that this very fear disturbs their quiet and prevents them 
from sleeping. 

Schools. 

He has also recently organized a class of excited patients, which he 
examines each day when passing through the wards. Thirty were in 
attendance on the day of our visit, and we found them more quiet and 
orderly than at any other time. All would clamor for "the privilege of 
showing how well they could read, or repeat some little piece of prose 
or verses of poetry that they had committed for the occasion, but as 
soon as the doctor would decide who was entitled to the floor, all became 
quiet and listened attentively till the piece was spoken, when they would 
rise to their feet and again put in their claims, and so on to the end of 
the recitation. They really seemed to take great interest in these exer- 
cises, and doubtless many moments of comparative happiness were 
passed in learning their lessons that would otherwise have been spent in 
miserable contemplation of their unhappy condition. These schools 
have long existed in some of the continental asylums, and a few in Great 
Britain and Ireland, though this was the first and only one we have seen 
especially devoted to the excited patients. Music, drawing, and singing 
are taught in most of the Italian asylums and in some of those in other 
countries. At A versa, near Naples, there is a regular band, who play 
for their own amusement and that of the other patients. A theater has 
been fitted up, in which they play, give concerts, and other entertain- 
ments; and here, as at York, in England, and Morningside, in Scotland, a 
printing press has been provided, and the patients encouraged to write 
articles that are set up and printed by themselves. Here, too, as at 
Lyons, in France, Ghent, in Belgium, and Wakefield, England, we saw 



185 

many looms, on which the patients wove the cloth used by the asylums. 
At San Servalo, in Venice, the band plays every day from eleven to 
twelve, and the patients are as much delighted as if at a regular concert, 
while those who belong to the band gave signs of evident satisfaction. 

In some of the asylums in Milan, schools have also been established, 
but we will only make an extract from our notes of a visit .to one of 
them, the last we visited in Italy: 

April 3d — To-day we visited the private asylum of Doctor Serafino 
Biffi, one of nature's noblemen, who seems as generous as a prince and 
as kind as a woman, one of those real loveable men with whom we 
sometimes meet in our journey through life. The asylum is a quiet, 
homelike place, such as we might expect to grow up under the care and 
management of so good a man. No pains have been spared to make it 
in reality a home for the homeless, and a retreat for the heavy hearted 
and afflicted. Two teachers are employed, who, in addition to other 
branches, teach vocal and instrumental music. They play and sing with 
as much accuracy and expression as if no illusion or hallucination dis- 
turbed their minds. They played and sang several pieces and tunes for 
our benefit, and showed us some of their paintings and drawings that 
would have been a credit to artists of no ordinary pretentions. Twenty 
of the seventy-four patients in this asylum were engaged in these occu- 
pations at the time of our visit, and as good order prevailed as at any 
school to be found. Others were reading, playing billiards or draughts, 
while others still were promenading about the beautiful grounds. 

This, as we have stated, is a private asylum, where patients are 
charged from sixty cents to two dollars per day, and is not given as a 
specimen of the public institutions, which are greatly inferior to it. 

The most thoroughly organized school that we have anywhere seen, 
however, was in the Richmond Asylum, at Dublin. The system has 
been completely established, and the organization as perfect as any 
schools in the country. The able Superintendent, Doctor Lalor, has 
taken great interest in and paid particular attention to the subject, 
demonstrating not only the possibility of promoting good order and 
discipline by means of schools, but also of increasing the knowledge 
and improving the morals of persons while in a state of insanity. There 
were about nine hundred patients in the asylum at the date of our visit — 
August twenty-ninth, eighteen hundred and seventy-one — more than a 
fourth of whom attended school. In the school for males we saw one 
hundred and twenty engaged in their recitations and exercises, which 
were conducted with perfect order and propriety. Eeading, writing, 
arithmetic, object lessons, music, drawing, and painting are taught, and 
Doctor Lalor informed us that considerable advancement had been made 
by some, while all had been benefited in a moral point of view; self- 
control, power of concentration, and regularity of habits had been 
attained in many instances where they had been totally absent before; 
and that he regarded the school as one of the chief agencies in promot- 
ing good order and in establishing a comparative degree of contentment 
and cheerfulness in his asylum. The school for females is conducted on 
similar principles, though needlework is added to the list of studies in 
this department. Six teachers, three of either sex, are regularly 
employed, at salaries about double the amount paid attendants, and in 
addition to their duties as teachers are required to assist in " keeping the 
house in order." Some of them always accompany the patients in their 

24 



186 

walks outside the asylum walls, in the public park, and other places to 
which they are permitted to go. These teachers, being better educated, 
more intelligent, and of a higher order than those whose services can 
be obtained for the ordinary wages paid attendants, exercise a salutary 
influence over the patients at all times. Their morals, habits, and man- 
ners, being thus cultivated and controlled, are necessarily improved, and 
we confess our surprise at having seen this kind of occupation intro- 
duced into so few of the asylums of our own country. 

DIRECTORS AND SUPERINTENDENTS. 

Unfortunately the custom still prevails in some of the asylums on the 
continent of placing a Director at the head of the institution. Its gen- 
eral management, the power to employ and discharge all the attaches 
and attendants, and to say how the patients shall be fed, clothed, and 
occupied, are invested in him, though generally a non-medical man. The 
Medical Superintendent occupies a subordinate position. He of course 
prescribes the medical treatment for all, and the diet for the sick, but no 
other powers are assigned to him. As may readily be supposed, this 
divided responsibility begets evil results. The physician is lessened in 
public estimation; the employe and attendant look to the Director for 
his position or his place, and naturally take sides with him in any con- 
flict of opinion that may arise. They place themselves in antagonism to 
the wishes of the physician, and. but half carry out his orders, and thus 
destroy the harmonious workings of the institution. 

In Great Britain no man is chosen as Superintendent of an asylum who 
has not served as an assistant. He must be armed with recommenda- 
tions as to his qualifications, standing, and moral character, and is sub- 
jected to a searching examination. Having passed this ordeal and 
obtained the position, he retains it for life, unless removed for cause. 
He has supreme control of the asylum over which he presides, nominates 
his assistants and other officers, and selects his attendants. He is paid a 
liberal salary, and given one month's leave of absence each year for 
recreation; and after serving fifteen years is alloAved an annuity equal to 
three months of his salary, provided he desires to retire from service. 
Harmony is the result of this system, and the consequence is good order 
and thorough discipline in every asylum in Great Britain. 

Under these circumstances, men of the highest order of intellectual 
capacity and thorough education prepare themselves for the position of 
Superintendent, and being under a local Board of Managers, and sub- 
jected to periodical visitations by the Commissioners in Lunacy, strive 
to merit their good opinion. These Commissioners are always men of 
first class ability, high character, independence, and influence, who make 
searching examinations, and comment upon matters as they find them, 
without fear or favor, and are a power in the land that cannot be ignored 
nor disregarded. 

The vigilance exercised by the Boards of Commissioners in Great 
Britain, and the admirable organization above referred to, make their 
system superior to any that elsewhere exists, and should be adopted in 
all countries with centralized Governments and circumscribed bound- 
aries. The form of our Government, composed of thirty-seven States, 
each managing its own local affairs and having its own method of pro- 
viding for the insane (even if the vast extent of territorial limits did 
not forbid), would render it impossible for such a system to be adopted 
in the United States, while the small number of asylums in most of the 



187 

States would not justify the establishment of Boards of State Commis- 
sioners. 

In Ireland and in some asylums on the continent, in addition to the 
resident officers, a Visiting Physician is appointed, who makes regular 
visits and consults with the Superintendent. The advantages claimed 
for this custom by the Directors are, that he forms a link between the 
asylum and the outer world; that the people have more frequent oppor- 
tunities to coDverse with one who. is in constant communication with the 
patients within; that they can make more frequent inquiries about their 
afflicted friends; and that a physician engaged in general practice is 
better prepared to treat diseases of a purely j)hysieal character than one 
who has devoted his time to the study and his energies to the treatment 
of insanity alone. 

An asylum should be open to the friends of patients at all times, 
except when such visits might be thought by the Superintendent to be 
injurious to the patient; and even in this case the desired information as 
to his condition might as properly be communicated by the Superin- 
tendent as by the Consulting Physician. We are well aware of the 
injurious effects upon the patients of too much indiscriminate visiting by 
families or friends, but the propriety of these visits must be left to the 
discretion of the Superintendent or other resident medical officer, and 
these should ever be accessible to all who desire to make legitimate 
inquiry as to the condition, prospects, and treatment of their friends. 
They should be the "connecting link " mentioned by our friends in Ire- 
land. The last reason referred to is of still less weight. We cannot 
comprehend how any physician who does not thoroughly understand 
the pathology and treatment of physical diseases can successfully treat 
persons who are insane, since we hold that all cases of mental derange- 
ment are in some way connected with or dependent upon physical 
disease. 

ATTENDANTS. 

To accomplish the best results, however, in addition to a skillful med- 
ical staff and proper hospitals it is all-important that intelligent, patient, 
and self-sacrificing attendants should be procured; those who will not 
only be attentive to their duties, but are kind and cheerful in disposition, 
and who are possessed of tact and discriminating judgment. 

For these reasons, liberal wages should be paid, and a system of 
rewards established for those who are faithful to their trust and con- 
tinue in the service. Reasonable leave of absence should be given at 
regular intervals to admit of visits to family or friends, and comfortable 
quarters provided, that proper rest may be procured and contentment 
prevail. Seeing that their comforts, happiness, and interests are not 
overlooked, they will become interested in the duties assigned them and 
in the general welfare of the institution with which they are identified. 

In some asylums in this country and in Europe the wages of attend- 
ants are regularly increased for a given number of years, and in some of 
those in England and on the continent an annuity is allowed after a con- 
tinuous service of fifteen years. These are all good features that may 
well be considered in the organization of a hospital for the insane, as 
nothing is more detrimental to the harmonious management of an asy- 
lum than inefficient and constantly changing attendants. The best 
authorities agree that there should be at least one attendant for every 
ten patients; and we are thoroughly convinced that the number has not 
been placed too high, for though some classes of patients require less 



188 

than this proportion, others need more, and cannot be properly treated 
or managed without them. 

We also observed in a few of the English asylums a man and wife 
acting as attendants in the wards for infirm men, and learned from the 
Superintendents who had adopted the system that it gave great satisfac- 
tion to the patients, and always added to the neatness and cheerfulness 
of the wards. That the restraining influence of woman and the sooth- 
ing effects of her tender care w T ere as apparent among the insane as 
among sane men; and if this be true, all will admit the propriety of the 
system. For ourself, we would at any time rather be nursed by one 
woman than ten men, and in this respect we probably agree with all 
classes of our fellow men. 

We have thus given a brief synopsis of the treatment of insanity and 
the management of insane persons, as practiced in some of the best asy- 
lums in most of the enlightened countries of the world; and it may 
fairly be presumed that the medical men who have charge of them are 
among the most able and learned of the profession to which they belong. 
From this we hope the non-professional reader may be able to form 
some idea of the methods of general treatment ordinarily adopted in 
the usual forms of insanity. No specific treatment can be laid down 
that would be applicable to the same class, as this must vary with the 
peculiarities of each case.- But we desire to impress this important fact 
upon the public mind, that "insanity is a disease of the brain affect- 
ing the mind," and that an asylum is nothing more than a hospital 
adapted to the treatment of this peculiar malady; that patients commit- 
ted to its care will be skillfully treated and kindly nursed, and that if 
sent in the early stage of the disorder a large majority will be restored 
to health and to reason. 






CHAPTER XIV. 
INSANITY IN GENEKAL. 



Increased attention to Insanity — Growth of Hospitals in United States — Increase of Hos- 
pitals in United States — Increased Accommodation — Hospitals exhibit Insanity — Non- 
residents — Should other States send their Insane to California — Insanity in other States 
— Results of Treatment — Curability of the Insane— Effects of Early Treatment — Good 
Hospitals necessary to Favorable Results — Results in our Asylum — Doubtful and Hope- 
less Cases— Economy of Early Treatment — Probable Duration of Life in Chronic Cases 
— Increase of Patients in our Asylum — Causes tending to this Result — Will the Chil- 
dren of Foreigners be as liable to Insanity as their Parents — Observations upon Phys- 
ical and Moral Causes producing Insanity — Intemperance a Leading Cause, of Insanity 
— Duty of State relative to Asylums — Physicians not generally Informed on the Sub- 
ject of Insanity — Psychology recommended to be Taught in Medical Schools — Effect 
of the Liberal and of the Economical Plan of Care and Treatment. 

INCREASED ATTENTION TO INSANITY. 

From the foregoing considerations, derived from various sources and 
authorities, setting forth the history of insanity, the receptacles in 
which the lunatics were kept, and the methods of treatment pursued 
towards them, we learn that it is only within a century that it dawned 
upon the world that lunacy was curable in any considerable degree. 
The doctrine, however, made very slow progress and but few converts. 
Even in the beginning of this century, hospitals were built to give to 
the insane a more humane confinement than the prisons in which they 



189 

had been kept could afford; and it was not till within the recollection of 
many now living that the faith in the curability of the disease became 
general, even among professional men. Hence, hospitals began to be 
built for the twofold purpose of custody and curability, for beside the 
difficulty of managing and taking care of lunatics at home, it was found 
that comparatively few recovered. From this period hospitals began to 
be regarded as not only the best, but to most persons the only place for 
the insane. Hence an increasing 'demand for their accommodation, and 
though their numbers have multiplied with astonishing rapidity, and 
have greatly increased in size, they are still inadequate for the recep- 
tion and accommodation of all who knock at their doors, and with 
piteous appeals seek admission for the treatment they afford and the 
benefits they are known to confer. At the beginning of this century 
there were only four receptacles for the insane in the United States, and 
only one of these, that at Williamsburg, Virginia, devoted exclusively to 
the treatment of insanity. Previous to its establishment, however, in 
seventeen hundred and seventy-three, a ward had been set apart for 
their accommodation in the Pennsylvania Hospital, and contained eigh- 
teen patients as early as seventeen hundred and fifty-two. Similar insti- 
tutions followed in seventeen hundred and ninety-seven — the Maryland 
Hospital, at Baltimore, and the Bloomingdale Asylum, at ISTew York. 
But little attention, however, had yet been paid to this subject, and, as 
will be seen from the following table, no other asylum was established 
till eighteen hundred and seventeen, when the Friends opened one at 
Frankford, near Philadelphia, followed the year after by the McLean 
Asylum, at Somerville, Massachusetts. 

GROWTH OF HOSPITALS IN UNITED STATES. 

Showing date of establishment of the following Asylums, with a list of those 

in process of erection. 

The following hospitals first received insane patients before the year 
eighteen hundred: 



Philadelphia, Penn., Hospital.. 1752 
Williamsburg, Va., established 
at that time 1773 



Baltimore, Md 1797 

Bloomingdale, K Y. : 1797 



Asylums Established between 1800 and 1820. 

Frankford 1817 | McLean 1818 

From 1820 to 1830. 



Bloomingdale ..1821 

Columbia, S. C 1822 

Lexin gt on, Ky 1 824 



Hartford, Conn 1824 

Staunton, Ya 1828 



From 1830 to 1840. 



Worcester, Mass 1833 

Baltimore, Md.. 1834 

Brattleboro, ¥$.. 1837 



Columbus, Ohio, destroyed by 

fire 1839 

Boston, Mass 1839 



190 
From 1840 to 1850. 



Nashville, Tenn 1840 

Augusta, Me 1840 

Philadelphia, Penn., Hospital 

for Insane 1841 

Concord, K H 1842 

Milledgeville, Ga 1842 

Utica, N. Y .-...1843 



Insane Department of Phila- 
delphia Almshouse 1845 

Flushing 1846 

Providence, E. 1 1847 

Indianapolis, Ind 1848 

Jackson, La 1848 

Trenton, K J 1849 



From 1850 to 1860. 



Jacksonville, 111 1851 

Fulton, Mo 1851 

Harrisburg, Pa 1851 

Stockton, Cal 1852 

Longview, 1853 

Madison, Wis 1854 

Taunton, Mass 1854 

Hopkinsville, Ky 1854 

Jackson, Miss 1855 

Flatbush, L. 1 1855 

Canandaigua, N. Y 1855 



Dayton, 1855 

Washington, D. C 1855 

Dixmont, Pa. 1856 

Baleigh, K C 1856 

Auburn, N. Y 1858 

St. Vincent, Mo 1858 

Northampton, Mass 1858 

Kalamazoo, Mich 1859 

Troy, R Y 1859 

Newburgh, O 1859 



From 1860 to 1870. 



Kellyville, Pa. ^....;. ;.1860 

Tuscaloosa, Ala..... 1861 

Mt. Pleasant, Iowa 1861 

Blackwell's Island, N. Y 1861 

Philadelphia City Asylum 

Immigrant, N. Y 1861 

Austin, Texas 1861 

St. Peter, Minn 1866 



Portland, Or 1869 

Weston, W.Ya : 1866 

Ossawatamie, Kansas 1866 

Mt. Hope Eetreat, Md 1867 

Alameda Park, Cal....'. 1867 

Middletown, Conn 1868 

St. Louis, Mo 1869 

Ovid, N.Y 1869 



From 1870. 
Howard Grove, Eichmond, Ya 1870. 

ASYLUMS IN PROCESS OF ERECTION. 



Anna, 111. 
Elgin, 111. 

Independence, Iowa. 
Catonsville, Md. 
Towsontown, Md. 
Ward's Island, N. Y. 



Poughkeepsie, N. Y. 
Columbus, O. 
Athens, O. 
Danville, Pa. 
Buffalo, N. Y. 
Middletown, N. Y. 



ESTABLISHMENT OF ASYLUMS IN THE BRITISH PROVINCES. 



Toronto 1841 

Quebec 1848 



St. John, K B ..1848 

Halifax, N. S 1859 



During the next ten years, eighteen hundred and twenty to eighteen 
hundred and thirty, the Bloomingdale Asylum was rebuilt, and four 






191 

others added to the list. During the next ten years a like number were 
built, but it was not till after eighteen hundred and forty, about the time 
the mind of the English public was directed to the abuses existing in- 
the asylums of that country, and the heroic efforts of Doctor Hill, 
Charlesworth, and Doctor Conolly to abolish the vile and cruel custom 
of confining nearly all patients sent to asylums with chains, handcuffs, 
and the straight jacket, had been crowned with success, that a general 
interest in the subject, and a corresponding impetus was given to the 
erection of asylums in this country. And as the result we see that 
during the next ten years eleven asylums were built. In the ten years 
that followed twenty-one were established; till to-day, as we see from 
the table, no less than sixty-six asylums in perfect operation, accommo- 
dating seventeen thousand seven hundred and thirty-five patients, exist 
in the United States, to say nothing of twelve others in process of erec- 
tion. Some of these, in architectural elegance, completeness of design, 
convenience of arrangement, adaptation to the purposes for which they 
are intended, and beauty of location, are unsurpassed, if indeed they are 
equalled by any institutions in the world. 

SHOWING INCREASE OF HOSPITALS IN THE UNITED STATES. 





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23,191,876 
31,443,322 
38,555,983 


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4,730 ] 

f8,500 ] 

- 17,735 S 


11 


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1850 


15,610 
23,999 
37,382 


28 
50 


.68 
70 


30.30 


1860 


35.42 


1870 '.. 


6Q 


168 


47.44 



It is not in our country alone, however, that this increased attention 
has been paid to the requirements of these unfortunate people. We have 
already pointed out this fact with regard to Germany, and we might do 
so for every country we have visited — France, Italy, Belgium, Holland, 
Ireland, Scotland, and Canada — but will be satisfied with a table setting 
forth this progress in the United States and England, as specimens of 
the whole: 



* Including idiots, as these two classes were not separated until the census of eighteen 
hundred and fifty. 



t See Journal of Insanity, Vol. XVIII, p. 2. 



192 



Table, 



Showing the per cent of the Insane provided with Hospital Accommodation in 
the United States and England at different periods. 



UNITED STATES. 


ENGLAND. 


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tiospi 

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3 


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sane 
hosp 
mod 






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a 


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1850 


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4,730 


30.30 


1847 


26,516 


13,832 


52.00 


1860 


23,999 


8,500 


35.42 


1857 


33,791 


21,344 


63.00 


1870 


37,382 


17,735 


47.44 


1867 


49,082 


31,914 


67.00 



INCREASED ACCOMMODATIONS. 

From the above table it will be seen that of the whole number of luna- 
tics in England in eighteen hundred and forty-seven, fifty-two of every 
hundred were provided with asylum accommodation; and in eighteen 
hundred and sixty-seven, sixty-seven per cent were provided for. In 
eighteen hundred and fifty, the asylums in the United States accommo- 
dated only thirty per cent, and in eighteen hundred and seventy, forty- 
seven per cent. As rapidly as insanity has appeared to increase in these 
countries within the twenty years specified, this shows that the pro- 
visions made for the care, comfort, treatment, and restoration of its vic- 
tims have outstripped it by fifteen per cent in England, and in the 
United States by seventeen per cent. 



*As given* in the reports of the Commissioners in Lunacy, including idiots. 



193 



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194 

Although this table does not show that ninety, nor even eighty per 
cent have been restored in those cases treated within twelve months 
after the accession of the cfcsease, it does show that of all the recoveries 
more than seventy-eight per cent were cured within that period, and 
that less than twenty-two per cent were cured where the treat- 
ment was commenced after the disease had existed more than one year. 
It is the experience of the Southern Lunatic Asylum, of Ohio, that only 
seventeen per cent get well where the treatment has been deferred for 
two years and over, and in some other asylums that only eight per cent 
recover under such circumstances. Let us add to the large percentage 
of recoveries of those treated in the early stages of this malady, the 
usual number of deaths occurring in asylums, and it is quite certain 
that a small proportion only would remain as chronic cases to be sup- 
ported by the State during the remainder of their days, which, as will 
presently appear, is about seventeen years. 

GOOD HOSPITALS NECESSARY TO FAVORABLE RESULTS. 

These results, of course, can only be expected, under the most favor- 
able circumstances, when all of the conveniences, comforts, and ap- 
pliances of the most approved hospitals and the best medical treatment 
are brought to bear upon the disease. It is hopelessly impossible for 
any amount of care and attention, any degree of medical skill that the 
power of man can supply, to overcome the disadvantages and drawbacks 
of a poorly constructed hospital, with its ill ventilated and overcrowded 
wards, where proper classification and necessary sanitary regulations 
cannot be fully carried out, such, unfortunately, as are some of the 
wards in our own asylum. But notwithstanding all of these drawbacks 
and disadvantages, the percentage of cures to admissions is surpassed 
by a few only in any country. 

RESULTS IN OUR ASYLUM. 

In eighteen hundred and seventy there were but few asylums in the 
United States that showed so large a percentage of recoveries, while 
the average in all is far below ours. This may be accounted for in a 
measure from the fact that a large majority of the patients are sent to 
our asylum at an early period after the accession of the disease, while it 
is yet within reach of the physician's skill; and none can doubt that the 
same amount of care, watchfulness, and skillful treatment in a better, 
arranged and less crowded hospital would largely augment the per- 
centage of cures and lessen the percentage of deaths. They are sent 
to the asylum at an early period because it is not only known that they 
will be received, but kindly and skillfully treated, and that the chances 
of recovery are greatly in their favor. The very character of the popu- 
lation, too, leads in some degree to this result. Many are without homes 
and families; but few are blessed with kind and steadfast friends to 
look after, watch, and nurse them when the evil day comes, and as there 
is no other place for them they are sent to the asylum, fortunately for 
them, in time to be treated while there is yet hope of recovery. Under 
these circumstances a large number get well and are restored to society 
and the State. But, as already stated, under more favorable conditions, 
with a hospital less crowded and better ventilated than many of the 
wards in our asylum are, with facilities for proper classification, and 
where there are not so many for the medical officers to watch and pre- 



195 

scribe for, a much larger number would recover. Abundant evidence 
has been adduced in another place to show that large asylums are not 
considered the best in any point of view — neither for curative purposes 
nor on economical grounds; the latter being the only argument that has 
ever been brought forward to justify large establishments for the treat- 
ment of the insane, 

DOUBTFUL AND HOPELESS CASES. 

We are fully aware that many cases of insanity are incurable from 
the beginning. The very causes producing it places recovery beyond 
the bounds of probability, if not of possibility. Thus, when apoplexy, 
palsy, or consumption, epilepsy, or even masturbation is the cause pro- 
ducing mental alienation, there is but little hope, and all who have been 
deprived of treatment for more than two years have forfeited their best 
chances of recovery and gone within the limits of chronic insanity, 
from which but few return with mental integrity. Fortunately, there is 
not a large proportion of these committed to our asylum, and had the 
oft repeated recommendations of our Superintendent been heeded by our 
legislators the accumulated numbers would not have reached such 
appalling proportions. 

SOME SELF-LIMITED, BUT MOST REQUIRE TREATMENT. 

While the cases we have been considering are of such a hopeless 
character, others appear to be self-limited, and if left to themselves or 
removed from exciting causes and disturbing influences will recover. 
But far the greater number require treatment, medical and moral. In 
most instances this can only be accomplished in hospitals. Men of dis- 
ordered mind, when they need a change of air or scene, cannot go to a 
hotel or private boarding house, or even to the house of a friend, when 
they are so fortunate as to have the one or possess the means to com- 
mand the other. They require more caution, forbearance, and oversight 
than those who are mere invalids suffering from ordinary diseases. 
Many of them are suspicious, and annoying to those about them, and 
dangerous to themselves and others. They must therefore go to hos- 
pitals, places, or people devoted to their care, and prepared to give them 
the needful attention and watchfulness. But hospitals are too expensive 
to be provided even by the rich, while a large majority are poor or 
entirely destitute. It is therefore the duty of the State to provide these 
hospitals, that all may receive the early treatment so essentially neces- 
sary to their restoration, not only that they may cease to be a burden 
upon the State, but that they may return to it and to society the benefits 
of their labor and usefulness. 

ECONOMY OF EARLY TREATMENT. 

To show more clearly the economy of early treatment, the following 
table has been prepared and introduced. It shows that of all the cures 
effected in the Worcester Hospital during a period of fifteen years, those 
treated during the first year of the attack required an average of five 
months and ten days; while all who recovered whose treatment com- 
menced after the expiration of one year, required to be treated ten 
months and ten days — showing conclusively that it cost the State only 
half as much to cure the earlier cases. And when it is considered that 



196 

more than three times as many of those treated in the early stages got 
well than of those treated at a later period, it will be seen that the 
advantages of the former are immense. 

Let ns add to this the large proportion of those who never recover 
when treatment is postponed, and who consequently are added to the 
chronic list to be maintained through life, and some idea of the advan- 
tages of early treatment may be comprehended by the dullest mind. 
The table also shows that the average duration of treatment in those 
who died during this period was four years, three months, and twenty- 
two days. 

Table, 

Showing the duration of Insanity of those who recovered in the Worcester Hos- 
pital from 1833 to 1848. 





3 


Total Duration 


Average Dura- 


Total Time in 


Average Time 




B 


of Insanity. 


tion. 


Hospital. 


in Hospital. 


Duration of In- 


cr 1 

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sanity previ- 


























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B 


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One year or less. 
More than one 


1,179 


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41 


1,181 


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10 


12 


173 

33 


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6 


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2 




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9 


10 


Unknown 




?4 





















Duration of Insanity of those who Died. 



No. Cases. 


Years. 


Months. 


Days. 


Years. 


Months. 


Days. 


272 


1,171 


5 


29 4 3 

i 


22 



Probable Duration of Life in the Incurable Insane. 





Males. 


Females. 


Average Duration of Life. 


Age. 


Insane. 


Sane. 


20 


21.31 


28.66 


24.99 


36.32 


30 


20.64 


26.33 


23.46 


34.54 


40 


17.65 


21.53 


19.59 


23.46 


50 


13.53 


17.67 


15.60 


19.59 


60 


11.91 


12.51 


12.21 


15.60 








16.74 


29 years. 






• 



197 

PROBABLE DURATION OF LIFE IN THE CHRONIC CASES. 

This table shows the probable duration of life in the incurable insane 
to be about seventeen years, while that of the sane of similar ages is 
twenty-nine years. This is doubtless as applicable to California as to 
Massachusetts and other countries, and will enable us to estimate with 
tolerable certainty the length of time we will have to support a large 
majority of those in our asylum at the j)resent time, as well as to appre- 
ciate the great difference between the cost of cure and the burden of 
maintenance. 

INCREASE OF PATIENTS IN OUR ASYLUM IN TEN YEARS. 

During the last ten years the average annual admissions in our asylum 
has been three hundred and fifty-eight, and the average annual increase 
sixty-seven. In eighteen hundred and sixty every fifteen hundred 
and thirty-two inhabitants of the State furnished one insane person 
from their numbers, and in eighteen hundred and seventy every nine 
hundred and sixty-four furnished a lunatic; or an average of one in 
twelve hundred and forty-eight for each year from eighteen hundred 
and sixty to eighteen hundred and seventy. This is an annual increase 
of twelve and six tenths per cent. Since the asylum was opened 
in eighteen hundred and fifty-one, there have been admitted five thou- 
sand six hundred and eighty-one patients, of whom forty- seven and 
sixty-eight one hundredths per cent were cured, nine and sixty-eight 
one hundredths per cent were discharged or removed uncured, twenty- 
three and forty-six one hundredths per cent died, and nineteen and 
eighteen one hundredths per cent remain, most of whom must be left as a 
charge upon the Treasury during the rest of their days. This is indeed 
a serious state of things, and behooves us seriously to look the facts in 
the face, endeavor to find the causes, and if possible devise means to 
arrest the progress of this fearful malady ere it gets beyond our power 
to control it. In eighteen hundred and forty-six, according to tables 
prepared by Doctor Campbell, of New South Wales, there was in that 
colony one insane person to eleven hundred and fifteen inhabitants, at 
the next census one to four hundred, and in eighteen hundred and sixty- 
seven the proportion had risen to one in three hundred and eighty-seven. 
This more nearly approximates the increase in California than that in 
any other country; and as there are many points of resemblance be- 
tween the two, it will be well to note what observers there have said in 
regard to the subject. Doctor Norton Manning, who was appointed by 
that Government to make an investigation similar to the one in which 
we have been engaged in behalf of California, made to his Government 
one of the most able, complete, and interesting reports that we have 
seen. A synopsis of this valuable document will be found in this report. 
On the increase of insanity he uses the following language: 

" This increase is to a great extent accounted for by the growth of a 
large mass of chronic insanity, which perhaps even yet has scarcely 
reached its limits. In the earlier emigrant days of the colony, notwith- 
standing, as has been said by an authority on this subject, that every 
emigrant ship brought one or two either insane or soon to become so, 
the vast mass of the population came in the prime of mental and bodily 
health. Their sick had been left behind in their fatherland. It would 
necessarily take some years for those becoming insane and remaining 



198 

incurable to grow old within the asylum walls, and reach by accumula- 
tion to that number of old, chronic, and incurable cases with which all 
other countries are burdened. It may be fairly estimated that, if the full 
extent of increase from this cause has not already been reached, it must 
soon be so, and that the number of removals by death will reach the 
proportionate number of yearly entries on this greater chronic list, and 
so a balance will be effected. Upon the whole, then, though the con- 
templation of this mass of suffering humanity must occasion deep sorrow, 
the Col'ony of New South Wales has cause for a feeling of satisfaction 
on estimating the number of its lunatic population. With -Some causes 
in -addition to those existing elsewhere, the ratio of its insane to popu- 
lation is not now markedly above that in most of those countries where 
the numbers have been ascertained with even tolerable exactness. These 
special causes will, it is to be expected, gradually disappear; the convict 
element will become fainter; the excitements of life will diminish; it 
may fairly be hoped that the use of poisonous alcoholic compounds, also, 
will decrease with the increase in quantity and diminution in price of 
wholesome colonial wine and beer, as well as under the better moral 
feelings of the future. With the diminution of these, the special causes 
of insanity in older countries may make their appearance; but it can 
scarcely be supposed that the ratio of insanity will rise higher than at 
present. A ratio equal to this, though the burden is great, is borne 
cheerfully by States not more wealthy than New South Wales, both in 
the Old World and the New." 

In speaking of the causes, he says: "First, the earlier population 
came under exceptional circumstances — the relations of crime and in- 
sanity are very intimate ; second, the ups and downs of early colonial 
life, the influence of the gold diggings; third, the lonely life of the 
shepherd, alternating with long periods of debauchery; fourth, the 
abuse of ardent spirits in a warm climate. On the other hand, the ab- 
sence of grinding poverty and the salubrity of the climate tend to dimin- 
ish mental disease." 

With the exception of the convict element in the population of New 
South Wales, what is here said is as applicable to this State as to that 
colony. 

CAUSES TENDING TO THIS RESULT. 

These causes have acted as powerfully here as there, and Br. Manning 
might have added, with equal propriety, other causes that act quite as 
potently in producing this malady as any of the foregoing : 

First — The total change in the habits of life. 

Second — The absence of those salutary restraints imposed by the pres- 
ence of well organized society. 

Third — The separation from family and friends; and, above all, the 
strange and mysterious influence of being away from home in a foreign 
land. In many cases with no mother nor sister near to watch over and 
care for them in sickness; no wife by to soothe their sorrows with cheer- 
fulness and smiles, and by tender sympathy drive away the gloom of 
despondency, and with heroic fortitude encourage them after failure in 
some cherished project again to buckle on the armor of determination 
and fight for success. 

All of these causes, and doubtless many others, must be operating, 
with various degrees of activity and power, on the foreign born citizens 
of our country and State — in what degree in the different States and Ter- 
ritories will be seen in the table next hereafter; while the succeeding 



199 

table has been prepared to show the relation of California in this respect 
to the whole country; the next to show the rate of increase of the popu- 
lation, the insane, and the idiotic, from the birth of the State to eighteen 
hundred and seventy; the next to show the percentages of these ele- 
ments; the next table shows that more than sixty -two per cent of the 
population of California in eighteen hundred and seventy were born in 
the United States, while less than thirty-six per cent of the insane were 
supplied from their number — being a proportion of one to eight hundred 
and fifty-eight. The proportion of citizens of foreign birth is thirty- 
seven and forty-five one hundredths per cent, and the proportion of the 
insane from their numbers sixty-four and thirty-nine one hundredths 
per cent, or one to two hundred and eighty-four; thus showing that per- 
sons of foreign birth are three times as susceptible to the invasions of 
insanity as those who were born in the United States. By reference to 
the table next hereafter, it will be seen that the proportion of the foreign 
element is much greater in California than in any other State, and there- 
fore we need not be surprised at the greater increase of insanity in our 
midst. And as the same causes, operating under similar circumstances, 
will always produce the same results, we may reasonably expect the 
growth of lunacy to continue till these conditions are changed. 



200 





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202 

RESULTS OF TREATMENT. 

"aving considered the subject of the treatment of insanity and the 
rapid growth of hospitals, and having shown how rapidly insanity itself 
has apparently, if not actually, increased in all countries during the last 
forty years, let us consider the far more important subject of the results 
of treatment in the various countries under consideration. The first of 
the accompanying tables shows the number resident at the beginning of 
the year, the admissions, numbers treated, recoveries, and deaths, with 
j)roportions of recoveries and deaths in the asylums of the several coun- 
tries from which returns could be obtained and of the latest dates that 
could be procured: 

While the last table sets forth similar facts for one hundred and thirty- 
six of the one hundred and forty-nine asylums visited, the results as 
exhibited in this table are for the year eighteen hundred and sixty-nine 
in the United States and Canada, and for eighteen hundred and seventy 
in the other countries. Though these tables differ in results in some 
respects, they agree in showing that the largest proportion of recover- 
ies to numbers treated and the smallest percentage of deaths to numbers 
admitted are in the United States. This, of course, may be the result of 
accident, as it requires a series of years and a knowledge of all the facts 
to enable us to draw positive conclusions in matters of this character. 
The average per cent of cures to admissions in all the asylums visited 
was thirty-four, while in the United States it was thirty-seven. The 
average of deaths to admissions in all was twenty-seven, and in the 
United States only seventeen. This we believe to be owing to the fact 
that the patients in our asylums are allowed a more liberal diet than in 
any other country, and that the debilitating effects of the continued bath 
so commonly used on the continent are entirely ignored in this country. 
There may be other causes operating to produce this remarkable differ- 
ence (sixty -three per cent) in the mortuary lists of all other countries, as 
compared with our own, though the two above cited seem fully adequate 
to the result. 

As already seen in the foregoing table, of all the patients admitted 
during the year, in the one hundred and thirty-nine asylums under con- 
sideration, thirty-four per cent were cured, and twenty-seven per cent 
died, leaving thirty-nine per cent, most of whom must be added to the 
chronic list, and thus swell the number of the insane. This is doubtless 
as favorable a showing as could have been made had all the institutions 
in the world been comprised in the list, as many of these are considered 
among the best asylums ever established, and are conducted by as able 
and learned men as have lived in any age. Well may we inquire, then, 
" if this is a necessary part of our natural condition or our civilization, 
to make this annual sacrifice of regiments of men and women on the 
altar of mental destruction, can the causes producing these effects in any 
way be avoided, and some of this sacrifice be prevented?" We will permit 
others of more experience and wiser heads to answer the question. 

CURABILITY OF THE INSANE. 

" In a perfect state of things, where the best appliances whi ch the 
science and skill of the age have provided for healing are offered to tho 
lunatics, in as early a stage of their malady as they are to th ose whe 
are attacked with fever or dysentery, probably eighty, and possibly 



203 

ninety, per cent would be restored, and only twenty, or perhaps ten, per 
cent would be left among the constant insane population." — Dr. Jarvis. 

Referring to this assertion, it is stated, in reference to the Utica Asy- 
lum, that " its influence has been such that every acute case happening 
in the county is at once placed under hospital treatment. The result is 
that <m\y five per cent of those treated in the early stage of the disease 
remain as incurables; thus more than verifying the assertion of Doctor 
Jarvis.* 

Doctor Tuke says: " It is of great practical importance to remember 
that the chances of cure are very much greater in recent than in chronic 
cases. This is clearly shown by the experience of the Retreat, in the 
following table :f 

Proportion of Recoveries on per cent of Admissions.. 



DURATION OF DISORDER WHEN ADMITTED. 



York Retreat— 1796 to 1857. 




Average. 



First attack and within three months 

First attack, above three and within twelve 

months 

]STot first attack, and within twelve months 
First or not first attack, and more than 

twelve months 

Totals 




44.2 

67.01 

22.59 



49.50 



73.10 

43.66 
63.77 

18.20 

49.44 



EFFECTS OF EARLY TREATMENT. 



The Superintendent of the Southern Ohio Lunatic Asylum, in his 
report for eighteen hundred and sixty-nine, shows how the expectation 
of recovery diminishes almost in exact proportion to the length of time 



the disease has existed, thus 



DURATION. 



One month 

Two months 

Three months.... 

Four months 

Six months 

Twelve months.. 

Two years 

Over two years, 



Admissions. 



* See Journal of Insanity, Vol. XXVII, p. 332. 
t See Bucknill and Tuke on Insanity, p. 261. 



530 
219 
164 
98 
177 
239 
163 
191 



Recoveries. 



363 
141 
88 
53 
83 
103 
47 
33 



Per Cent. 



68.49 
63.01 
53.65 
54.08 
46.32 
43.09 
28.83 
17.32 



204 

The above table is for the period of years from eighteen hundred and 
fifty-five to eighteen hundred and sixty-nine inclusive. 

This is a universally admitted fact which has been proved by the expe- 
rience of hospitals almost without exception, and is by far the most 
powerful agent that can be employed in preventing the increase of 
insanity in our midst — at least in preventing its accumulation in our 
asylums. But as the experience of individual asylums may not be con- 
sidered a fair test of so important a matter, we add the following table 
showing the results in many asylums in several countries for a series of 
years : 






205 



Deaths on Numbers 
Treated 



Deaths on Admis- 
sions 



Recoveries on Num- 
bers Treated 



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"-iS ~ 

^ .° 

■— ~ to 

g ^ 

to K| 



•o .^ 

to to 



C5 


5 




50 


&H 




^T 


c>-| 




O 


5>. 










-jo 






W 














►< 




^ 


-t~ 




* 


O 

to 


**» 




CI 










^ 


^s 


53 

Jo 


CI 


CO 




5-. 


►? 


CO 


«l 


-o 


S? 


co 


Ch 


Co 


s— 


CO 


^3 


^3 


s 


^o 


e 


CO 


S 


~ 




.« 








Jo 




>s» 


-to 


"^ 


CO 


S 




-+— 


53 




CO 


s 


CO 








■to 


-~ 






^ 


•o 




<S1 


> 


<i 


>> 




CO 
to 


t— 


<4i 




© 


~< 


« 


^ 


-to 


t^ 


^ 




O) 


CO 


r-^ 






CO 
to 


co 


^Q 







Proportion of the For- 
eign Insane to the 
Native Insane 



co 
ot 



Proportion of the For- 
eign Insane to the 
Foreign Population- 



Proportion of the Na- 
tive Insane to the 
Native Population... 



Proportion of the Total 
Insane to the Total 
Population 






EH 

w. 
Q 

!— I 
5 



Foreign Insane. 



Native Insane. 



Total Insane. 



Foreign Population. 



Native Population. 



Total Population. 



co 

Co 



O 

-1-3 



o 

CM 



O 



CM 

CM 



CO 



co 



CM 

GO 



co~ 

CO 

LO 



CO 

co 

CM~ 

CO 



CO 

GO 

to 

go" 

CO 



oi < 

a i— i 



- O 



2 Lh 

c5 O 



O 



o 



+3 
c5 



O 
pH 

So 

• r-l 

o 

O 

Cm 

O 

.2 

*-3 



o 



CO 
CM 



CO 
CM 



GO 
GO 



O 
CO 



GO' 



GO 

O 



208 
Table, 



Showing the Population and Numbers of Insane and Idiots in 1850, 1860, 
and 1870, with the proportion per one thousand of Insane and Idiots to 
Population, and the Annual Bate of Increase of Insane, Idiots, and total 
Population. 

CALIFORNIA. 





hi 

o 


S3 


3 

3 


o 

c-t- 

s» 


Batio per 1,000 of— 


Annual Increase of— 






H 
















P 


cr 1 

4 


a- 


H 

S3 












i 
i— i 


M 


M 


HJ H 

^ p 


i— i 




o 


o 


O 


P 


S3 W 




o §Ts» 




YEAR. 






M 


M 


o 


o* ^ 


2 <K 


a "s 


& p 


;/j 








3 


Pj 


p 


3 © 


3 c+- 




o ° 


p ? 












do 


O 


Oj 


: S - 


o 




^3 


c-t- 

o" 














9 

• 


08 

• 


Hi 
(^ 

o* 


; hi 

■ o 


c 

T3 

S3 




S3 M 

P& 
i i 










1850 

1860 


92,597 
379,994 


2 
456 


7 
42 


9 
498 


.02 
1.20 


.07 
.11 


.09 
1.31 


1 15.16 


72.1 


19.62 


1870 


560,247 


1,146 


87 


1,233 


2.04 


.15 


2.20 


3.95 


9.6 


7.55 



Table, 

Showing Total Population with Native and Foreign Population, and propor- 
tion of the Native and of the Foreign to the Total Population. 



YEAR. 


Total 
Population. 


Native 
Population. 


Foreign 
Population. 


Proportion of 

Native to 
Total Popula- 
tion. 


Proportion of 

Foreign to 
Total Popula- 
tion. 


1850 
1860 
1870 

■ 


* 92,597 
379,994 
560,247 


70,340 
233,466 

350,416 

• 


21,802 
146,528 
209,831 


75.96 
61.43 
62.54 


23.54 
38.56 
37.45 



* In eighteen hundred and fifty the nationality of four hundred and fifty-five persons 
was unknown. 

Table, ♦ 

Showing Total Number of Insane, with Native and Foreign Insane, and pro- 
portion of the Native and of the Foreign to the Total Insane, and of the For- 
eign to the Native Insane. 





Hi 


53 


Nd 


hi 


hj 


^d 


hj 




o 


& 


o 


S fl:3 


$ 2.3 ' 


j?^i?° 


2:^3.3 




p 




d 


3 ^ 


zjtr?^ 


O J<Jy 


2 O0<5 ^3 






i 


crq 


*^8 


* s .2 


3 r+ffi O 


^ 3 13 O 




M 








r-»- <^ 




< rt- 




YEAR. 


50 

P 




M 


h§ 


G 5 - 
H3B 


i 


ffi 3 2 


h< hj h 




O 


2 

CD 


SB 

P 

3 
? 


P Hrj 

5^ 


Ho 




?2 o 

a % j 


■gsg 






! 


' 


3 p 


i i 


i 


fg-? 


? S*? 


1850 


2 


I 

2 . 




i 

100 .... 




' 1 tr> 3K.T7fi 




1860 


456 
1,146 








1870 


408 


738 | 

1 


35.60 | 

i 


64 f 39 


1 to 858 


1 to 284 



209 



Table, 

Showing the total number of Idiotic, with Native and Foreign Idiotic, and 
proportion of the Native and of the Foreign to the total Idiotic, and of the 
Foreign to the Native Idiotic. 





-9 


^ 


^ 


hd 


* 1 


►d 


* 


Hd 






K> 


o 


a O 


^5 


2o 


?sj 


o o 




-1 




2. 


^2 


» 2 


g$ 




o'o 








2j c4- 


1—1 erf 


< <+ 




(-+■ <rf 


«rt- <rf- 




B^ 


H 


|— j 


S'o 


ho' 


T> o' 




° 5* 


°o 


j 
YEAKS. 




2: 

"5 


3' 

5" 


o' 

c-t- 


l-»5 


n of 
diotic. 


^ 




2 


hj2 
1 ~> 








: 


» 


i * 


3 ^ 




3^ 


E*0 








. 




• o 


O 




p 


§2. 
: Cg 


i 
i 

; 






: 


O 

o 


' c5 
: ctq" 


Q 

3 




^5 








; 


H 


. 








: •— i 








: 


o 
i 


i ° 1 


O 




i i 


: & 


1850 


1 \ 


6 


1 8 


5.71 


14.28 1 


6.66 


1 to 11,723 




I860..., 4 




1870 £ 


7 < 

1 


'0 


17 8 


0.45 


19.54 2 


4.28 


1 to 5.005 


1 to 12,343 









CALIFORNIA NO EXCEPTION. 

This shows that California is not an exception to the general rule; for 
while the insane have increased within her borders more rapidly than 
in any other country during the same period of time, it must not be 
overlooked that her citizens have not only been exposed to a greater 
number of causes by which this malady is developed, but that she is 
perhaps the only State in the Union, if not the only Government in the 
world, that has never refused admission to a single person who has 
sought to enter her asylum, notwithstanding it is a well known fact that 
among those received there have been and still are many citizens 
of other countries, who have not claimed California as a home, but who 
have come here hoping to better their fortunes and enrich themselves at 
her expense, and then return to their own homes and country; but failing 
to realize their dreams of wealth, give way to despondency, break down 
in health, or enter upon a course of reckless dissipation that leads them 
to insanity and to our asylum, either to be cured by our treatment or 
maintained through life at the expense of the State. 

How far this evil may be remedied or ameliorated by judicious legis- 
lation, is a problem that we are not prepared to solve; but surely it 
would seem that some preference should be given, some difference made, 
between this class and our own citizens; but if we must keep them, it 
does seem that the comity of nations should prompt them to reimburse 
us for the expenditure made. The doctrine has been proclaimed, and 
repeatedly confirmed by the superintendents of American institutions 
for the insane, and by those who have paid any attention to the subject 
the world over, " that it is the duty of every State to provide for its 
own insane." In this sentiment we heartily concur, and earnestly urge 
its adoption by our noble State, without equivocation or reservation. 
But the other is a very different question; nor do we now remember any 
instance of a declaration to the effect that it is the duty of one Govern- 

■27 



210 

ment to defray the charity expense of another. In other countries, and 
even in different divisions of the same country, persons of this class are 
often transferred to the communities to which they belong. The ques- 
tion is at least worthy of consideration. 

SHOULD OTHER STATES SEND THEIR INSANE TO CALIFORNIA ? 

In this connection another question, though intrinsically different, is 
nevertheless analagous to some extent, and deserves notice, not so much 
on account of its present importance as its future results. It is to inquire 
how far a sister State may be justified in establishing her institutions 
within the borders of another? Is it just or proper for one State to send 
all of her insane in the limits of another, even though she may pay the 
expense of care and maintenance? It is fair to. presume that when they 
are considered sufficiently recovered to require no further medical treat- 
ment that they will not be returned to the State from which they come, 
but turned loose upon the community where the asylum is located. 
Should a speedy relapse follow their discharge, they would of course be 
sent back to the asylum in which they had been treated; but when a few 
months have elapsed they would be committed under our laws, and sent 
to our asylum, and thus become an additional charge upon the State. 
We all know that a large majority of the insane are from that class who 
are not able to pay, and that persons who have been afflicted with this 
malady are more liable to be attacked than an equal number who have 
not been thus affected. The burden of all these will inevitably fall upon 
us. For these reasons it would seem proper for the State to express an 
opinion on this subject. 

WILL THE CHILDREN OF FOREIGNERS BE AS LIABLE TO INSANITY AS THEIR 

PARENTS? 

We do not know and have no means of ascertaining how far this 
liability extends to the children who are born of parents of foreign birth, 
but venture the opinion that it will be only in a small degree. If this 
hypothesis be correct, it must necessarily follow that the proportion of 
insane will diminish very nearly in proportion to the increase of the 
native over the foreign element in the mass of the people. This will of 
course become more and more rapid with each successive generation; 
for while the one is supplied with emigration from the other States and 
all the children born in the State, regardless of the nativity of their 
parents, the other must be increased by immigration alone. 

PHYSICAL AND MORAL CAUSES PRODUCING INSANITY. 

Having considered some, perhaps most, of the prominent causes of 
insanity, so far as it is affected in a social or political point of view, it 
may be expected that we will enter upon the consideration of the more 
prominent of the physical and moral causes leading to this malady; but 
we scarcely consider it necessary to do more than allude to some of 
them. We have already given a table showing a few of the more prom- 
inent assigned causes in all the countries visited during the prosecution 
of our mission, but Without special comment. By referring to that table 
it will be seen that they very generally agree with those operating in 
our State, but differing in degree and intensity in some countries. Thus, 
hereditary predisposition and intemperance are assigned as prominent 



211 

causes in all countries, and in Prussia and the German States they are 
the only causes of prominence f In Italy we find pellagra (disease of the 
skin peculiar to that country) added to the other two, while in most 
other countries we find added to the list ill health, pecuniary and domes- 
tic troubles, and spermatorrhoea, including self-abuse, etc. In our State, 
we see by the report of Dr. Shurtleff, just published, that masturbation 
still holds its place at the head of the list of assigned causes, though we 
agree with him that it is high time for " Committing Boards " to be more 
careful in their conclusions with regard to this particular cause. Many 
patients who have been received at the asylum with this charge of self- 
pollution resting upon them, have, after weeks or months of watchful- 
ness, been proved to be entirely free from such evil practices. That it 
is a cause in some cases we have every reason to believe; and further 
than this, when it is the cause its victims rarely recover; they seem to 
be doomed from the very beginning. There are other cases in which it 
is merely a symptom of a diseased brain, or some of its appendages — an 
effect, not a cause. These cases are more hopeful when treated in time. 
Indeed, many men of prominence with whom we have met on the conti- 
nent, in Great Britain, and in the United States, believe that it is almost 
universally the effect of insanity, and not its cause. 

INTEMPERANCE A LEADING CAUSE OF INSANITY. 

With regard to intemperance the case is altogether different. It 
seems to be the bane of all countries, and claims its victims in every 
civilized nation and under every form of government. It is the common 
enemy of mankind, the destroyer of domestic happiness, the copartner 
of every crime, from petit larceny to murder. It is the father of pov- 
erty, the creator of debauchery, and the principal working tool of the 
Devil. ~No man is bold enough to defend it, and yet it is tolerated by 
all classes of society. It finds its way alike to the house of the rich and 
the home of the poor. It is a boon companion at the festive board of 
the aristocrat, and the poorly provided table of the cottager. It has 
caused more heartaches, produced more tears, engendered more sorrows, 
starved more babies, and led to more insanity than any other agent in 
existence — if not more than all others combined. We are strongly 
inclined to the opinion that directly or remotely it is more potent in pro- 
ducing these results than all other causes. It is the sin of civilization 
that it has found out manifold ways of extracting alcohol from natural 
substances, so that it is offered in tempting forms and accessible abundance 
to the weak and incautious, who would not instinctively seek it, as well 
as those whose appetites demand it. If, then, civilization is responsible 
for the introduction of this destructive element among mankind, it is 
certainly its duty and it should be compelled to provide for its victims. 
How to arrest its progress, if, indeed, it be possible, we must leave to the 
wiser heads of the legislator and the statesman; and he who can solve 
the problem will be the wisest of men, and a greater benefactor to his 
fellow men than has ever yet appeared among them. 

We have thus briefly considered this last, as it is the most prolific, 
among the causes that have given us so large a number of persons de- 
prived of their reason; who crowd the wards of our asylum till there is 
scarce sleeping room or breathing space for the numbers they contain, 
to say nothing of the accumulations that must take place ere additional 
accommodations can be provided for their reception. The question must 



212 

be determined as to what is best to be done in performing our duty and 
relieving their distress. 

DUTY OF THE STATE RELATIVE TO ASYLUMS. 

The State must elect whether it will build other hospitals, and thereby 
pay the cost of cure, or support all those for life who become incurable 
from our failure to provide sufficient and suitable accommodation for 
their early, treatment — whether to make the effort to regain a productive 
citizen, or support a non-producer for seventeen years. We must either 
provide hospitals for the reception of every citizen who may become 
insane within our borders and under our jurisdiction, or surrender this 
noble charity to degeneracy and decay. As already stated, this has 
been done. No other State, so far as our knowledge extends, has done 
so much j a fact that is doubtless a source of gratification and pride to 
every man who claims California as a home. We regret, however, that 
candor compels us to say that some of the wards of the male department 
of our asylum are wretched in the extreme, and would be disgraceful 
if not taken in connection with the fact, that the number of applicants 
have been so far beyond expectation as to render it next to impossible to 
provide accommodations for them all. Eeceived they have been, but 
during the last two years at the discomfort of many who were thus 
compelled to give up a portion of the space, already too small, that had 
been allotted to them. Doctor Shurtleff in his report just published, 
has truly said "the rooms are not only full % but crowded." In addition to 
this, two hundred and twenty-seven patients are sleeping on beds nightly 
prepared for them in the halls. The number in excess of the accommo- 
dations has grown to proportions too vast to admit of being properly 
provided for by the erection of cheap detached wards. The institution, 
in point of numbers, is already double the size of the average of similar 
institutions in the other States. With the completion of the new build- 
ing, therefore, all further expansion should be discontinued. This done, 
aside from the cost of support, every other effort and expenditure in 
behalf of the asylum at Stockton should be directed to repairs, the con- 
struction of inclosures, and the improvement of the grounds, etc. 

" If this view be concurred in, the only alternative left is for the State 
to make further provision elsewhere. The character, extent, and loca- 
tion of such provisions are questions upon which every possible light 
should be shed. In character, nothing less than a first class hospital, 
with all the modern improvements and appliances for the curative treat- 
ment of such as may be benefited thereby, and for the proper care of all 
classes of the insane, will meet the general approval of the most experi- 
enced;" and, we may add, the expectations of the people of the State. 
Doctor Shurtleff continues: "If additional provision for the care of the 
insane be made at some other place than Stockton, the question of locality 
is one of no less importance than those of character and extent. Topo- 
graphical and climatic fitness are matters of such primary importance 
that they will not be likely to be overlooked. Convenience to the great- 
est number who will be likely to need its benefits is a very important 
consideration, in many respects, in the location of a hospital for the 
insane. Officers' fees and travelling expenses, which depend on the 
distance, and are a public charge generally, the difficulty and even danger 
in conveying the insane, and the visits of friends, are all matters which 
should be considered and have their influence in arriving at conclusions. 
In this connection it should be borne in mind that of the five hundred 



213 

and twenty-three patients admitted during the last year, about three 
hundred came from the counties bordering on the Bay of San Francisco, 
and that two hundred and twenty-two — more than two fifths of the 
whole — came from the City of San Francisco alone. This proportion is 
no exception to those of several years past." 

These suggestions, emanating from Doctor Shurtleff, a close and accu- 
rate observer, with a correct judgment, and a larger experience than any 
man on this coast, should not be lightly passed over nor disregarded. 
They are the results of serious reflection on an important subject with 
which he has been intimately identified for years, and his conclusions 
can be maintained with manifold reasons of the strongest character. 
With a single exception, that of size of hospital, they entirely accord 
with the views expressed to your Excellency soon after the completion 
of our visit to nearly one hundred and fifty asylums, wherein we had 
noted with especial interest, among other things, and observed with 
more than ordinary scrutiny and careful consideration, the effects of 
overcrowded wards and courtyards, the location and sites of asylums, 
their nearness to and distance from some city or important town, the 
character of scenery, quantity and quality of land, the sources of 
water supply, the facilities of communication, the convenience and cheap- 
ness with which fuel, supplies of all kinds, and building material could 
be obtained, as well as all other matters in any way connected with the 
construction, ventilation, warming, organization, etc., of hospitals for 
the insane, and which are treated more or less at length under their 
proper heads; and above all, to the importance of locating these institu- 
tions in the midst of those most likely to require the benefits they 
confer. 

In many of the States inadequate provisions are made for treating 
the insane, followed by the most disastrous results. Large numbers 
who desired to gain admittance have been turned away and told, " not in 
words, but in acts that are more powerful than words," to wait till some- 
body gets well or dies, and then after the disease has fastened itself upon 
your brain so firmly that it cannot be removed, when all hope of recovery 
has passed, you may come in, and in your turn keep some other equally 
unfortunate person out till he, too, becomes hopelessly incurable, lost to 
himself, lost to his family, and lost to the State — yet a burden to the 
public treasury so long as he shall live. No one who is at all familiar 
with the nature of this malady will deny these facts; every person who 
has written or spoken upon the subject during this generation has 
asserted them till they have ceased to be denied. 

Last year, as we learned from personal information obtained from 
some of the superintendents of asylums, and from the published reports 
of others, the following facts existed: 



At Staunton, Virginia, of two hundred and eight applicants, only 

fifty-nine were admitted; rejected 

In the Michigan Asylum, rejected 

In the Asylum in North Carolina, rejected 



149 
155 
150 



Dr. Everts, of the Indiana Asylum, informed us that not more than 
one third could be accommodated in that State, and as three hundred 
and fourteen were admitted, it follows that six hundred and twenty- 



214 

eight must have been rejected. Yes, strange as it may appear, this 
young and vigorous State, the sixth in point of population in the Ameri- 
can Union, and, as we are informed, the only one free from the burden 
of debt; with low taxation and abundant resources; with one mil- 
lion six hundred and eighty thousand six hundred and thirty-seven 
inhabitants, has turned away from her asylum two thirds of her own 
unfortunate children who have sought relief at her hands. Who could 
have believed it possible in this enlightened age that any community of 
American citizens could be guilty of such cruel practices and such par- 
simonious conduct as this? And yet the fact is as stated. Doctor Hills, 
of West Yirginia, reports from sixty to seventy-five in the Jails of that 
young State; and the State Board of Charities report thirteen hundred 
and twenty-six in the poorhouses of New York. The States of Maine, 
Iowa, Illinois, and others are no better off. Unlike Indiana, however, 
most of these States are making noble efforts to remedy this evil, because 
they recognize the obligation and the duty, and feel no disposition to 
shirk the responsibility nor to avoid the expense. Indeed, we would 
like to know what right a State has to make such unjust distinctions 
between its citizens; to say to one, "Come and be healed," and to 
another, " Go hence; you shall not partake of the benefits you have 
helped to create." To one, "You shall come in, be fed, clothed, housed, 
and nursed; our physician shall minister to your diseased frame and 
release your troubled mind from its agonizing thraldom." To the other, 
" We have no house to shelter your head from the pitiless storms; no 
food to appease your hunger; no raiment to cover your nakedness or add 
to your comforts; no nurses to watch over you in sickness and minister 
to your necessities. For you there is no sympathy; you must take care 
of yourself, pay your own expenses, and provide for your necessities as 
best you can. For you l there is no balm in Gilead, there is no physician 
there.' " 

What is the result of this policy? Nine tenths of these people have 
no means of consequence. While in the possession of health, and en- 
dowed with that greatest of earthly blessings, their reason, they were 
able to support themselves, and, it may be, lay up a little something for 
their families; and if this had not already been exhausted by ill health 
or other cause that has led them gradually to insanity, this calamity has 
deprived them of the chief part if not all of their capital — the ability to 
work. The family who have hitherto depended upon these resources 
must now look to other means and other persons for support. They 
cannot afford to send this afflicted member of the family to a private 
asylum — it may be in another and distant State — nor can they afford to 
keep him at home and have him properly treated. They are out of rela- 
tion with social and domestic life, and should go away. It is often the 
case the very presence of family and home is a source of annoyance and 
vexation that they cannot endure. 

THE INSANE CANNOT BE KEPT AND CURED AT HOME. 

They are a great burden to the family, and disturb its quiet and its 
peace; and if retained, as is not unfrequently the case, drag all down to 
poverty and misery with themselves. Besides, they require to be man- 
aged with fitting wisdom, that few can give, however willingly and 
cheerfully disposed, and with that amount of patience and forbearance 
not often found outside of asylum walls. Indeed, many cannot be man- 
aged at home on account of a disposition to wander, to be violent, or 






215 

destructive. Some cannot be persuaded to submit to the needful reme- 
dies for their proper treatment, even when this could be obtained. 

PHYSICIANS NOT GENERALLY INFORMED ON THIS SUBJECT. 

Unfortunately, but few of the medical men in general practice in our 
country or any other have made themselves familiar with this myste- 
rious disease and its proper treatment. The reason of this is obvious — 
it is a branch not taught in any of our medical schools as a part of the 
course. It is not a part of the curriculum in the colleges of any coun- 
try; hence, proficiency in this branch is not a " sine qua non " for a medi- 
cal diploma. They are sometimes called upon to pronounce as to the 
sanity of some unfortunate person and to decide whether or not he is a 
proper subject to be sent to an insane asylum. In the majority of cases 
they have never seen the patient Wfore and never see him afterwards. 
Again : when some criminal puts in the plea of insanity to save his neck 
or his reputation, the physician is called upon to justify in the case, and, 
as often happens, is mortified to find that the lawyer knows more about 
the subject than himself. The one has "read himself up " for the occa- 
sion, and can ask more questions than an author of medical jurispru- 
dence could answer satisfactorily to the Judge or jury; while the doctor, 
perhaps, has given the subject but little thought or attention. "We trust 
this condition of things will soon be changed, as more attention is being 
paid to the subject both in this country and Europe. 

PSYCHOLOGY RECOMMENDED TO BE TAUGHT IN THE MEDICAL SCHOOLS. 

The Superintendents of many of the asylums in Italy, Austria, Ger- 
many, France, and England are giving courses of lectures on the science 
of psychology, and the Association of Medical Superintendents of Ameri- 
can Institutions for the Insane has strongly recommended its adoption 
as a branch in the medical schools of this country. When this sugges- 
tion has been carried out a wonderful advance will have been made in 
the right direction and many persons saved from the calamity of chronic 
insanity by having their diseases early detected and properly treated. 
But let us return to our patient who has not been able to procure proper 
treatment in an asylum in time to obtain even a chance of recovery while 
relief was possible, and we find him at last admitted to a place made 
vacant by the death of some patient who has paid his last debt to the 
"grim tyrant," or the recovery of some other who, more fortunate than 
himself, was received in proper time. But, alas! it is too late for him. 
His case has become chronic, perhaps incurable, and he is doomed to eke 
out a wretched existence — a burden to himself and to the State during 
the remainder of his days. 

EFFECTS OF LIBERAL AND ECONOMICAL PLAN OF CARE OR TREATMENT. 

The following extracts from the report of the "Worcester, Massachu- 
setts, Hospital for eighteen hundred and sixty -two, will show the effect 
of the two policies on the use of hospitals, and cure of patients : 

" The natural effect of the liberal and the economical policies of offer- 
ing the hospitals to the use of the people, is manifest in the different 
ratios of the patients sent in the early and in the later stages of their 
malady to the hospitals in Massachusetts and Ohio. 



216 

" In Ohio seventy-three and one seventh per cent, and in Massachu- 
setts sixty-four and one eighth per cent of the patients in their State 
hospitals were sent in the first year after they were attacked. 

" As a necessary consequence, those States which sent the largest pro- 
portion in the early and curable stage received back the largest propor- 
tion in health and power of usefulness, and had the smallest proportion 
left in confirmed immovable lunacy to be supported for life by their 
estates or the public treasuries. 

" In the three public hospitals of Ohio, fifty-four and fifty-nine one 
hundredths per cent of all that were sent to them were restored, and 
forty-three and forty one hundredths per cent remained insane for life. 
In Massachusetts, forty-four and five one hundredths per cent were 
restored, and fifty -five and ninty-five one hundredths per cent remained 
a life burden on the people. ^ 

" It must be remembered in this COTinection that the reports of admis- 
sion into the hospitals of Massachusetts include both the foreign or 
State paupers who are admitted free, and the American paying patients 
who are charged more than the cost for their support. If distinction 
were made in the reports, and it were shown how many of each of those 
two classes were sent in the several stages of their disorder, it would, 
without doubt, be found that a much larger proportion than thirty-five 
and two one hundredths per cent of the native patients were kept out of 
the hospital until their disease become more difficult and even impossible 
to be removed. 

" It is not necessary to go abroad to find the connection between the 
terms of admission and support, and the readiness with which people 
avail themselves of hospital privilege for the cure or custody of their 
insane friends. We have proof of this in our own daily experience. 
Our Irish patients go free and stay without cost, and they are sent early 
and h*ave the best opportunities of restoration. The Americans go at 
their own cost, and pay all and more than all of the expense of their 
support, and consequently a large proportion are kept away, some for 
months and years, as long as their friends can endure or take care of 
them, and many for life, because their friends lack courage or money to 
take due advantage of the means of restoration so largely provided in 
the State. In eighteen hundred and fifty-nine, ninty-seven and five 
tenths per cent of all the foreign and only fifty-eight per cent of 
the native lunatics then living in the State had been sent to some 
hospital. 

" The proportion of patients restored out of all admitted to the hos- 
pitals, is twenty-three per cent greater in Ohio than in Massachussetts. 
£Tow, no one will suppose that the hospitals of Ohio are managed with 
more skill than those of this State. But the difference in the result of 
their labors is due to the difference in the proportion of patients sent in 
the curable stages of their disorder. 

" Looking upon this matter merely as a question of political economy, 
in its bearing upon the remote as well as present means and prosperity 
of the State, it is plain that there are important advantages on the side 
of the free and open system of managing these public charitable institu- 
tions. They send back to society a larger proportion of workers, pro- 
ducers, self-supporters, and contributors to the public treasury, and leave 
a smaller proportion of the useless and burdensome class. Inasmuch as 
they have a better or more available material to work upon, they pro- 
duce a more successful result, and convert a larger proportion of costly 
men and women into profitable members of the body politic. The Wor- 



217 

cester and Taunton Hospitals have received eight thousand four hundred 
and ninety, and restored three thousand seven hundred and forty to 
health. If these could have been sent at as early a stage of their dis- 
ease, and as large a proportion restored as in Ohio, then twenty-three 
per cent, or eight hundred and sixty would have been added to the use- 
ful and self-sustaining citizens sent back to the world, and as many 
taken from the class that has been or must be supported and cared for 
through life. 

"It must be further considered that it costs no more to administer 
these institutions on the free principles of Ohio than on the economical 
principles of Massachusetts. Both there and here provisions, groceries, 
clothing, labor, and salaries would be the same under either system. 
The only difference is in the way in which the cost is assessed upon the 
people. Here it is imposed upon tl^pse who receive the immediate per- 
sonal advantage, many of whom are the least able to bear it, and always 
at a period when they are the weakest, and any burden is distressing. 
In the other case, this cost of rescuing the people from permanent 
insanity, like the cost of schools, roads, Government, justice, and police, 
is assessed upon the whole community, in the proportion that each one 
is able to pay; and in both cases it comes out of the aggregate property 
and income of the Commonwealth." 

Any attempt to save money by failing to provide for the insane is 
indeed poor economy, and worse philanthropy. Let us, therefore, adhere 
firmly to the policy we have so wisely inaugurated, and which has placed 
us in the front ranks among the States of the Union and the nations of 
the world, and build asylums for all of our people who may be so unfor- 
tunate as to require their use and need their healing influence. In this 
connectiou, we deem it of some importance to introduce the following 
extract from a Message from Mr. Seward (when Governor of New York) 
to the Legislature : 

" I cheerfully express my approbation of the undertaking. Nations 
are seldom impoverished by their charities. The number of the insane in 
this State is not exaggerated, and I am not prepared to say that any 
erection less extensive would afford the space, light, tranquility, and 
cheerfulness indispensable to this interesting department of the healing 
art. Among all His blessings, none call so loudly for gratitude to God 
as the preservation of our reason. Of all the inequalities in the social 
condition, there is none so affecting as its privation. He sees fit to cast 
upon our benevolent care those whom He visits with that fearful afflic- 
tion; it would be alike unfeeling and ungrateful to withhold it. Let then this 
noble charity be carried forward, with what measure of munificence it 
remains with you to determine." 

Like sentiments have been proclaimed by the intelligent executive 
officers of most of the States of the Union, our own included, but unfor- 
tunately in too many instances legislators are frightened, or driven from 
their duty by the " criticisms of that class of public benefactors who 
make capital from their sympathy with our overtaxed people/' and no 
appropriation is made. Fortunately, at this time, however, no such 
objection can be urged. The Democratic party has seen the necessity of 
additional accommodations for the insane, and it only remains for the 

28 



218 

Kepublican party, ever the friend of progress, to carry forward the sug- 
gestion and complete the work. It is a noble charity, and no excuses 
should be needed to justify any appropriation that may be required, 
under judicious expenditure, to meet the necessities of the case; nor 
should the subject of politics weigh a feather in the balance of any 
man's mind in his considerations or his actions upon the subject. It did 
not do so two years ago, when the investigation was ordered to be made 
of which this report is the result, and there is no reason why it should 
do so now. Our labors have been performed with the hope that suffer- 
ing humanity would be the gainer by the results, and if this shall prove 
to be the case we will have reaped the most earnest desire of our heart, 
and a reward beyond price. Hence we have ventured the suggestion 
that the one party and the other will be equally responsible for any 
appropriations that may be made apd equally entitled to the honors of 
so beneficent a deed. 

" We can lose nothing by our charities in this direction." Let us not 
only provide ample accommodations for all of our insane, but let us so 
locate our asylums that they will be easily accessible to the greatest 
number of those who will probably require their use, and then with an 
enlightened public opinion all will be encouraged to seek the benefits of 
early treatment and speedy restoration. Comparatively a few only will 
be left as permanent charges to the State. A much greater number will 
be restored to usefulness and labor. The State will be the gainer by 
the operation, and humanity will smile at the triumph of wise legislation 
and judicious treatment over the most appalling disease with which the 
human race has ever been afflicted. 



CHAPTEB XV. 



INSANE ASYLUMS — ECONOMY OF PROVIDING AMPLE CURATIVE ACCOMMODA- 
TIONS. 

Before entering upon the discussion of the plan of building best 
adapted to the care and treatment of the insane, we desire to call the 
attention of the business man, the financier, and the taxpayer, as well as 
the legislator, to the economy of restoration and the amount saved the 
State by the cures already effected in our asylum. 

A similar showing was made by Doctor Jarvis a few years since to 
the State of Massachusetts, and to him we are indebted for the idea and 
most of the facts set forth in this article. We have applied them to 
California, and in making the argument must necessarily touch upon 
some matters already considered. It is a proposition universally admit- 
ted that it is the first interest of every State to preserve itself, to develop 
its own strength, and to sustain it to the fullest degree. The strength 
and wealth of the State are the aggregate of the wealth and power of 
the individuals who compose it. If a member of the community is 
strong, his strength increases the power of the State. If he be a pro- 
ducer and create riches, this adds so much to the common wealth. 

If, on the contrary, he become sick or weak and lose his power of pro- 
duction, his loss of personal power takes so much from the general 
power. His failure to add to his own estate is so much loss to the gen- 



219 

eral prosperity. If, more than this, lie loses power to provide for his 
own w an ts, his support becomes a charge upon property that he or others 
have created, or are at the time creating. If his own means or those 
of his family are insufficient for this purpose, then the public treasury 
must and does assume the burden. 

Whether this support of a dependent citizen comes from his own or 
others' estate, or the general treasury, it inevitably comes from the 
property of the commonwealth, either that which has already been paid 
in form of taxes to the Government, or that which, in the hands of indi- 
viduals, is the basis of taxation. In either case the body politic is the 
loser to the extent of the cost of supporting the disabled person. 

In all cases this cost is first chargeable to the estate of the one sup- 
ported. If that be wanting, then his natural friends should pay it; and 
if they fail, the expense falls on the town or State. This last resort is 
sure, for the town or State is. the responsible indorser of every sick, 
disabled, or insane person within its borders, to restore him to health or 
support him through life. 

There is in every community, especially in such as have had a genera- 
tion of existence, a large body of the insane who are a constant burden 
on its resources. In Massachusetts, in eighteen hundred and fifty-five, 
there was one insane person in every four hundred and twenty-seven 
living. In other States and counties there are estimated to be from. one 
in four or five hundred to one in a thousand. A part of these are the 
recent cases, that have a hope of restoration; a larger part consists of 
old and incurable cases that have been submitted to the healing pro- 
cesses without avail, or have been neglected until the day of relief was 
past. 

The burden of supporting these is constant, unavoidable, and very 
great. It is the first claim of humanity, as well as the duty and interest 
of the body politic, to keep the numbers of these as small as possible, by 
healing all that can be healed in the curable stage of their disorder, and 
allowing none but those whose disease is primarily incurable to fall into 
chronic and permanent lunacy. 

Insanity, although it suspends the power of production, self care, and 
self support, is not in itself very dangerous to life. A man becoming 
insane at twenty, if not restored, has a prospect of living, on an aver- 
age, twenty-one years in lunacy; but if restored his prospect is for 
thirty-nine years in health. The average of life for a permanent lunatic 
is twenty years, and for a sane man thirty -two years, from their thirty- 
first year; and these prospects are respectively seventeen and twenty- 
six years from their forty-first year. Persons taken with lunacy at these 
ages have, then, the doubtful prospect of living twenty-one, twenty, or 
seventeen years, more or less, according to the age when attacked, in 
dependence, a burden on their own or the public estate, if not restored; 
or of being cured and of living thirty-nine, thirty-two, or twenty-six 
years, more or less, in health, ability to take care of themselves, and 
add to the strength and wealth of the community. 

Insanity is one of the most removable of grave diseases, if the proper 
measures are used in its early stages, as they are in cases of fever, dys- 
entery, etc. The experience of hospitals shows that from seventy to 
ninety per cent may be thus restored to health. The average time 
required for restoration in hospitals varies from five and a half to seven, 
and even eight months. But the average of the whole, especially those 
taken early, does not exceed six months. 

The average cost of supporting patients in the California asylum for 



220 

the four last years was thirteen dollars and eighty-five cents ($13 85) a 
month. This is eighty-three dollars and ten cents ($83 10) for six 
months, and one hundred and sixty-six dollars and twenty cents 
($166 20) for a year. The actual cost of restoration necessarily includes 
the whole expense of the experiment. It is impossible to determine in 
advance who may be restored — who must remain uninfluenced by reme- 
dial measures. These must then be used for the whole; some may be 
restored in a few weeks, others in all periods from this to two years and 
more — averaging six months to all; but none must be given up as incur- 
able until they have had at least two years trial of the means of cure. 

The cure of the seventy-five per cent thus necessarily involves the 
necessity of two years board and care of the other twenty -five per cent. 
This must also be included in the list of cases and assessed upon the 
seventy-five who are restored. 



The cost of seventy-five cured, for six months is 

The cost of twenty-five not cured, for two years each is. 

Total 



$623 25 
831 00 



,454 25 



Assessing this equally upon them makes the average cost of curing 
the insane in California to be one hundred and ninety -three dollars and 
eighty-six cents. 

It must be remembered that this cost of supporting seventy-five for 
six months and twenty-five for two years in a hospital — fourteen hun- 
dred and fifty -four dollars — for the restoration of the seventy-five is not 
so much additional expense thrown upon the people. These hundred 
persons were already insane, helpless, powerless, unable to support them- 
selves. They were already thrown upon the community and its indi- 
vidual members, who were responsible for their maintenance whether 
they were sent to the hospital or not; whether any attempt was or was 
not made to restore them. The Commonwealth collectively, or its 
estates separately, must pay the cost of their board, care, and guar- 
dianship. 

It is questionable whether out of a hospital, a private house, or other 
abodes, at home or with strangers, these patients could obtain food for 
less than it cost the asylum for them — three dollars and twenty cents 
($3 20) a week. If not, then the curative measures in the asylum 
caused no additional expense to the State or its people, except the cost 
of the establishment itself. The interest on the capital; the wear and 
depreciation of the buildings; the cost of repairs; the insurance, and 
the taxes which would otherwise have been paid to the public treasury 
on this amount of property, are properly chargeable to the cost of curing 
the insane, and nothing more. 

Here, on the contrary, must be weighed the gain to the community 
from the restoration of the insane to health. The annual earnings of a 
man over and above the expense of his living ^nay be considered as an 
annuity, or so much annually contributed to the commonwealth. Accord- 
ing to the best European calculations of these values — the earnings and 
expenditures — the present worth of the excess of the former over the 
latter, for an unskilled laborer at twenty-five, is twelve hundred and 
eight dollars ($1,208). That is, such a laborer at that age is worth so 



221 

much to the body politic. This is the English, and very nearly the 
German valuation. In this country wages are higher and earnings 
more, and of course the annuity and its valuation are greater. This, 
too, is the estimated value of an unskilled laborer, who earns the lowest 
wages. The value of the skilled mechanic, the merchant, the profes- 
sional man, whose earnings are larger, must be very much greater. It 
is at least safe, then, to assume the European calculation of twelve hun- 
dred and eight dollars as the average worth of men of all conditions 
and occupations in California who may become insane at the age of 
twenty-five. 

This is lost by his lifelong insanity. Add to this the cost of his sup- 
port, at least as great as that charged in the asylum — thirteen dollars 
and eighty-five cents a month, one hundred and sixty-six dollars and 
eighty-five cents a year, for an average of twenty-one years : 



Making for each unciired patient a total expenditure for sup- 
port 

Add the loss of the value as a producer 

Showing a total loss of. 



$3,490 83 
1,208 00 



$4,698 83 



So much is gained by restoring an insane laborer twenty -five years 
old. It would have been less if he had been older, with a prospect of 
fewer years before him; it would have been .more if he were a mechanic 
or man of business, with power to earn more if in health. The cost, 
only one hundred and ninety-three dollars, is neutralized by the consid- 
eration that it Would have been as great for his support if no attempt 
had been made to restore him. 

During the twenty years of the operation of the California Asylum, 
five thousand six hundred and eighty-one lunatics were admitted. Of 
these two thousand seven hundred and nine, or forty-seven and sixty- 
eight one hundredths per cent, were restored. This relieved the State 
and people of the burden of supporting these through life in their dis- 
ease. Taking the numbers in their several ages, their average life, if not 
cured, would have been twelve years each; or the whole sum of their 
insane lives would have been thirty-two thousand five hundred and eight 
years, and their life support, at one hundred and sixty-six dollars a year, 
would have been four million four hundred and ninety-seven thousand 
and four dollars, which was saved for the State. Their average valua- 
tion, considered merely as laborers earning the lowest wages, when 
restored to health and productive power, was eleven hundred and two 
dollars each; making a total of two million seven hundred and sixty- 
three thousand and eighteen dollars which was regained. Both of these 
make a total of seven million two hundred and sixty thousand and 
twenty-two dollars which has been gained to the State and people by 
the restoration of these twenty-seven hundred and nine insane persons 
in the asylum at Stockton. 

This calculation presupposes that all these were original cases, and 
then no readmission; but although the record does not state it, there 
must have been here, as elsewhere, periodical cases, some being more 
than once and some several times attacked, sent to the hospital, and 
there cured. These of course had shorter periods of health than this 



222 

average, and their years should be deducted. This would reduce the 
sum, but would still leave a very great amount lost by uncured insanity. 



CHAPTER XYL 



INSANE ASYLUMS— PLAN BEST ADAPTED TO CAEE AND TREATMENT 

OF THE INSANE. 

General Observations — Cottage System — Farm Asylums— Close Asylums — Pavilion Plan. 

GENERAL OBSERVATIONS. 

From the foregoing considerations, then, there will be no question that 
the State has a very great interest in the cure of the insane. Yet there 
may be a question as to the best manner of effecting it. We have 
already shown why they cannot be properly cared for, treated, and 
cured in private houses, at least in California; and also why we prefer 
moderately small to very large asylums. As it is not probable, however, 
that an appropriation could be obtained for two asylums with a capacity 
for two hundred or two hundred and fifty patients each, in accordance 
with our views, we trust that none for more than four hundred patients 
will ever be built. In saying this, we have not forgotten the suggestion 
made, that the north wing of the Female Asylum at Stockton should be 
finished. It must be remembered that the removal of two or three most 
uncomforable, unsightly, and objectionable wards was at the same time 
deemed a most desirable end to be accomplished, so soon as a new 
asylum could be erected; and furthermore, that having already con- 
structed a centre building (always the most expensive part of any 
asylum), together with kitchen, chapel, engine house, boilers for heating, 
and otner necessary comcomitants for an asylum to accommodate a 
given number, this improvement can be made at less cost than at any 
other place, to say nothing of the pressing demands for the room it would 
more speedily supply than in any other way. We have an asylum at 
Stockton which in some respects is not what it should be; and we desire 
to see these evils remedied. The improvements suggested would accom- 
plish this object; nor do we consider this improvement at all incon- 
sistent with the views expressed with regard to the size of asylums; 
this would only be the completion of a hospital already begun, and is 
simply a matter of necessity; whereas a different system may and should 
prevail in the construction of all asylums to be hereafter built. 

THE COTTAGE SYSTEM. 

We have already had occasion to speak of the different kinds of asy- 
lums in vogue in several countries, in our sketch of the report of Doctor 
Manning. What he had to say of the cottage system, as practiced at 
the Colony of Gheel, and the modification of that system, as adopted to 
some extent in Scotland, entirely agrees with the conclusions at which 
we ourselves had arrived: that however well adapted the system may 
be for old and thickly settled communities, it is " altogether inapplicable 
to a new or sparsely settled country." Much has been written upon 
this system by some of the foremost men of the Continent, of Great 



223 

Britain, and the United States; some advocating its adoption in their 
respective countries, while others condemn it in no mild terms as being 
unworthy even of respectful consideration. Esquirol, Guislain, Moreau, 
Parigot, Bulckens, DeMundy, Duval, Boiler, Droste, Halliday, Ste- 
vens, Brown, Sibbald, Earle, Gait, Tyler, Bemis, and a host of others, 
have visited the famous old Colony at Gheel, and given the results of 
their experiences and observations to the world. Manning came next, 
and we followed in the wake of all, and had set forth our views at some 
length, not only with regard to Gheel, but also the Scotch system, of 
keeping a certain class of lunatics in private dwellings. But as we have 
no Gheel in America, and no such population as that among whom 
lunatics are kept in Scotland, it is unnecessary to print them. 'Nine 
tenths of the patients kept at Gheel in Belgium, and at Kennoway in 
Scotland, we believe, are better satisfied than they would be in hospitals; 
but it would be impossible to induce our people' to take charge of such 
patients for the cost of keeping them in our asylums. Hence, it would 
be useless to discuss the cottage system with a view to its adoption in 
our country. 

We refer the curious, and those who may desire to learn more of the 
history of Gheel and the cottage system, to the interesting essays of Dr. 
John Sibbald, of Scotland, who has written the most satisfactory account 
of them with which we have met, and which may be found in the Jour- p 
not of Mental Science for April, 1861; to that of Dr. Henry Stevens, pub- 
lished in the same journal for April, 1858; and to that of Dr. Merrick 
Bemis, to be found in the Worcester Hosjntal Beport for 1869 — all of 
which, with numerous other articles upon this and kindred subjects, are 
among the books which now adorn the shelves of the medical depart- 
ment of our State Library. Indeed, with Winslow's Psychological Jour- 
nal, the Journal of Mental Science, and the American Journal of Insanity in 
our library, to say nothing of the large number of other works that 
keep these company, it would be difficult, if not impossible, to touch upon 
any subject relating to insanity that cannot be found ably and thoroughly 
discussed in some of them. Had a tithe of the information which they 
contain been known by our people, or could they have been accessible to 
all, then, indeed, would this report have been a useless undertaking; but 
should it only serve to direct public attention to them, and to the subjects 
of which they treat, will much good have been accomplished. 

For a thorough understanding of the Scotch system, we refer the 
reader to the interesting work of A. Mitchell, M. D., " On the Insane 
in Private Dwellings." 

The plans that we have selected for publication in this report are 
chosen from a large list, and are believed to be specimens of the best in 
the world. There are many others equally good, and in giving prefer- 
ence to these we by no means intend or desire to disparage others. All 
cannot be published, and to insert an account of so many asylums, such 
as we find in our notes, would constitute a volume, and must therefore 
be omitted, however agreeable it would be to us to give our exj)erience 
of each institution visited. We must therefore be content with descrip- 
tions of a few only, as samples of the best, and again refer the reader 
to the journals and other works on the subject already alluded to, for 
any additional information that may be desired. 

FARM ASYLUMS. 

The farm asylum — of which Clermont, with its colony of Fitzjames, 



224 

about fifty miles from Paris, is perhaps the best specimen — possesses 
some advantages, in an economical point of view, but would scarcely be 
applicable in this country. It consists of an asylum proper, situated in 
the Town of Clermont, and is intended for all patients who cannot safely 
be trusted with the liberty given the patients at the colonies. One of 
these, called " Fitzjames," is near the town, and is approached by a wide 
avenue, finely shaded by trees. Here there are several buildings appro- 
priated to the use of the different classes of patients, who pay from 
thirty francs a month to three hundred. Those paying the higher 
prices have rooms to themselves, a larger number of attendants, better 
diet, greater facilities for amusements and entertainments, and are not 
required to work. Of this class there are very few. Those who are 
charged thirty francs a month are paid for by the Department from 
which they came, and are expected to do such labor as may be required 
of them. The colonies Contain one thousand acres of land, and the men 
work upon the farm, in the garden, and in the shops, while the women 
sew, do housework, wash, iron, etc. The buildings occupied by the men 
who work on the farm are two stories high, and consist of day rooms on 
the first and dormitories on the second floor. They eat in a common 
dining room, and no classification is attempted. The flouring mill, barns, 
stables, piggeries, sheep sheds, fowl yards, butcher shop, etc., are near 
m these buildings, and are all kept in the most complete order. They are 
under the management of M. Jules Labitte, one of the three brothers to 
whom the establishment belongs, while Doctor Gustave Labitte is the 
Physician in Chief of the entire establishment, having an assistant in 
each department. The buildings for the laundry women are located a 
few hundred yards distant from the last mentioned, and are of similar 
character. The lauudry itself is so constructed that a little river or 
stream, the Beronelle, traverses its entire length, and presents much the 
appearance of an ordinary mining flume, on either side of which the 
women stand and wash, after the custom of washerwomen throughout 
France. The othQr colony, " Yilliers," is about four miles from Cler- 
mont, and is conducted on the same principle as that at Fitzjames. Of 
the fourteen hundred and seven patients at this establishment three 
hundred and fifty are at Fitzjames, one hundred at Yilliers, and the rest 
at the establishment in Clermont. It is said to be a most profitable 
enterprise to its proprietors, and we were impressed with the idea that 
the patients were required to do more work than seemed compatible 
with their physical and mental condition; and the fact that nineteen and 
seven tenths per cent of recoveries and forty-five and two tenths per 
cent of deaths to numbers admitted were rej)orted for eighteen hundred 
and seventy is an additional reason to confirm this conclusion. Ordi- 
narily the labor of five lunatics is supposed to be equal to that of one 
person in perfect health, while many cannot labor for medical reasons; 
but here a much larger proportion are required to work, and more work 
required of them. Hence we conclude that this system could not be 
successfully carried out in our country and among our people. 

CLOSE ASYLUMS. 

This brings us to the consideration of the close asylums, including the 
corridor, house, and pavilion plans. All of these have their peculiar 
advantages and their strenuous advocates. Plans of each will be found 
in Appendix F of this report. All have notes of reference explanatory 
of the design, and some have been described. 






225 

The asylums in the United States have nearly all been constructed 
on the corridor plan, with centre building and wings. The plans of the 
proposed asylum at the City of Boston, the Pennsylvania Hospital for 
the Insane, and the Michigan State Asylum, though differing in some 
respects, are all of this character, and are considered among the best in 
this country, and we think are not surpassed by any in the world. None 
of them could be built for less than one thousand six hundred dollars per 
patient, and the Pennsylvania Hospital for the Insane — known as the 
~New Kirkbride Asylum — with all of its appurtenances would probably 
cost two thousand dollars per patient. It is a corporate institution, 
intended for and patronized by the wealthy or independent classes, who 
pay from fifteen to thirty-five dollars per week, which enables it to fur- 
nish many advantages, comforts, and luxuries, and sources of amuse- 
ment and diversion, that would be beyond the reach of institutions 
intended mostly for the accommodation of indigent or non-paying 
patients. Its caj^acity is for two hundred and fifty patients. 

The Michigan Asylum is a State institution and was designed for three 
hundred, and cost four hundred thousand dollars; while the plan of the 
Boston Asylum was also intended for three hundred patients, and was 
estimated to cost four hundred and ninety-eight thousand five hundred 
and three dollars. 

Descriptions of these asylums will be found elsewhere in this report, 
and it is only necessary to say here that all of them might be built in 
such manner as materially to lessen the cost and yet retain the general 
design of the structures and convenience of internal arrangement. We 
will mention a few of the most prominent. The expensive apparatus 
necessary to forced ventilation might in our climate be dispensed with. 
It is rarely cold enough in California at any season to render it neces- 
sary to close all the windows of a hospital, while in Summer the pre- 
vailing winds afford an abundance of fresh pure air. The Boston plan 
is fifty-six feet wide, but we believe that thirty-six feet would be suffi- 
cient for all necessary purposes. This would give twelve feet for the 
corridors and ten feet in the clear for rooms — eight by ten being large 
enough for single rooms. Large dormitories we do not and never did 
fancy; one in each ward for five patients would be sufficient for most 
classes of patients, and anything larger than this might easily be pro- 
vided by having one wing on either side so constructed as to have the 
rooms only on one side the corridor, after the almost universal system 
of Great Britain and the continent, as may be seen in the plans of Apper- 
dix F, figures six, ten, twelve, and thirteen — the connection of the 
wings to the centre building and to each other giving an abundance of 
light and air. The bay windows and open sitting rooms at the end of 
each corridor are beautiful and most desirable features of this plan, and 
worthy of imitation in any new structure for the treatment of the insane.. 

In the Michigan Asylum the ceilings are fourteen and sixteen feet, 
which we think unnecessarily high. Eleven or twelve feet would seem. 
sufficiently high for the wards and fourteen feet for the centre building.. 
thus saving another item of expense. In addition to these items that 
may be saved without sacrifice to comfort or design, it must be remem- 
bered that in our temperate climate not more than half the quantity of 
piping and other apparatus for heating the building will be required as 
are absolutely necessary in the colder regions in which they are located. 
A most desirable feature in the Michigan Asylum, too, is the infirmary 

29 



226 

for those who are suffering from physical diseases, whether connected or 
not with their mental condition. There is one for either sex, and it is 
often a great comfort — sometimes the last — for these sufferers to have a 
dear relation or friend with them in such times of trouble, sickness, and 
need. 

With the features that we have pointed out in these two asylums, and 
with the wards for excited patients as they exist at the Pennsylvania 
Hospital for the Insane, combined to make one asylum for two hundred 
and fifty patients, supplemented with detached buildings, as elsewhere 
suggested, for one hundred and fifty more — such for instance as are 
being adopted in most of the first class asylums of Great Britain and the 
continent, we are confident that no better plan could be found in the 
world — whether for the purposes of cure or comfort; nor can we see 
any reason why such an establishment may not be as cheaply .con- 
structed as any other. 

In making these suggestions and giving preference to the asylums of 
our own country for the main building, we do not wish our kind and 
enlightened friends "on the other side of the water" to conclude that 
we have failed to appreciate the admirable features of their institutions. 
It is true that we have expressed our disapprobation of their congre- 
gated system — the common dining halls and large associated dormi- 
tories — because we believe them to be incompatible with proper classifi- 
cation. It seems to work remarkably well in that country, where classes 
in society are distinctly divided, and where most of the poor are kept in 
asylums prepared especially for their reception and accommodation, 
while the independent patients are sent to hospitals suitable to their 
social condition, either in separate institutions or separate buildings 
under the same superintendence. There, too, the people are more accus- 
tomed to regard those vested with authority as superior beings, entitled 
to command, and an inherent right to be obeyed. These ideas are rather 
strengthened than otherwise by insanity, and are carried into the 
asylum with them, causing them to submit, without complaint, to the 
rules of the asylum and to the orders of those placed over them. The 
English and continental asylums, therefore, may be well adapted to the 
treatment of patients thus constituted, but in our country the case is 
very different. Every man considers himself as good as any other, and 
generally claims that he has as much right to command as those whom 
he may have assisted to place in authority. Our people have, in their 
condition of health, an exalted idea of liberty, which is only perverted, 
perhaps, by insanity. To be thwarted in their designs or restrained in 
their actions is conceived to be a tresj>ass upon their inalienable rights, 
a curtailment of their freedom, which tends to excite and exasperate 
them. We cannot bring them together with impunity in such numbers 
as they are in other countries; besides, in this country, with few excep- 
tions, the asylums receive alike the rich and poor, the cultivated and the 
ignorant, the refined and the vulgar, who can only be separated by our 
corridor system, where each ward constitutes its own Utile family, with 
their own sitting and dining room, parlor, bath room, etc., which would 
be impossible with the English system. We are well aware of the 
advantages of the day rooms of the European asylums, which enables 
the dormitories to be vacated during the day and thorougly aired and 
ventilated. Hospital odors are less liable to accumulate, to become 
* offensive and unhealthy, and it may be that the patients learn the better 
to control their feelings and their actions by being brought in daily con- 
tact with a larger number of their fellows. Indeed, we are disposed to 



227 

think that a modification of our system in this respect might be made 
with advantage — that there might be one large dining hall, not for all, 
or for three fourths, but for one fourth of the patients in our asylums, 
where the men and women who were well enough and who desired to 
do so might meet and take their meals together. There is at present but 
one asylum in the United States (at Staunton, Virginia) where this is 
clone, and we were assured by Doctor Stribbling that it was considered a, 
great privilege by the patients, who used extraordinary efforts at self- 
control that they might not be deprived of it. Seventy-five out of three 
hundred and fifty patients were deemed proper subjects to be thus 
brought together, regardless of sex. 

PAVILION PLAN. 

The Virginia Asylum of which we have spoken, more nearly than any 
other in this country resembles the pavilion system now so generally 
adopted in all the new asylums that we saw in France, either as recently 
completed, or in process of construction, and of which the asylum at 
Auxerre (see plan App. F, fig. 14), may be considered a specimen. The 
plan recommended by the German Superintendents, and adopted by the 
authorities for the new asylum at Berlin, is also on the pavilion system. 
Many of the more recently constructed asylums in Great Britain have 
also adopted this plan to some extent, by supplementing the main hos- 
pital with detached blocks, such as we have suggested for a new asylum 
in California. 

The asylums at Brookwood, Brentwood, Glamorgan, "Warwick, Glou- 
cester, Colney Hatch, "Wakefield, The Friends' Retreat, JSTewcastle on 
Tyne, Cumberland and Westmoreland, Morningside, Cupar and Fife, 
Glasgow, the Richmond Asylum near Dublin, Cork, Quartre Mare, 
and the new Asylum San Yon at Rouen, Saint Ann at Paris, and many 
others, are either entirely on the pavilion plan, or are supplemented 
with detached blocks or cottages. The McLean Asylum at Somervillle 
near Boston, is another sample in our country; though we think the 
detached blocks in this asylum too small to be used profitably or with 
advantage in a State institution, as none should be built so small as to 
require less than two or three attendants, that at least one may be ever 
present in each ward where patients are kept.* 

In addition to this feature as taken from the European system, we 
cannot too strongly urge the adoption of another, which to our mind is 
the most charming of them all — we allude to the extensive and beautiful 
pleasure grounds by which the asylums of the Old World, and especially 
those of Great Britain, are surrounded. The bright and beautiful lawns, 

* For further information on the pavilion system, see Journal of Mental Science, for 
January, eighteen hundred and sixty-seven, an interesting paper ~by Doctor Lockhart 
Robertson, read at the annual meeting of the Medico-Psychological Association, held in 
Edinburgh, July thirty-first, eighteen hundred and sixty-six. Doctor Robertson is the 
able and well known editor of the Journal of Mental Science, ex-President of the Medico- 
Psychological Association, and for mstay years Superintendent of the Asylum at Hay- 
ward's Heath. 

The opinions of the distinguished psychologists of Germany will be of peculiar interest 
to all who can read German. Indeed, the shelves of our library now contain the opinions 
and suggestions of the ablest and most experienced men who have written on this subject, 
not only with regard to asylums, and hospital construction, but upon all subjects in any 
way related to or connected with insanity. 

The admirable Reports of the Commissioners in Lunacy for England and Wales, Scot- 
land and Ireland, are full of information and interest. We again invite especial attention 
to these works. 



228 

handsomely laid out and planted with shade trees, shrubs, and flowers, 
impress the beholder with satisfaction and delight, and must produce on 
the mind of the patient and his friends a feeling of pleasurable relief, 
that the bare walls of a hospital, however beatiful in design and elegant 
in structure, can never afford. 

It may be well in this connection to state that no asylum in Great 
9 Britain or upon the continent is built more than three stories, and in our 
opinion none should ever be in this or any other country. The centre 
building may be three, the first wings should be two, and the last but 
one. If covered with a French roof, the attic may be utilized either for 
dormitories for quiet chronic cases or for such other purposes as may be 
desired. ' JSTo ward should be built without a wide stairway of iron or 
stone at either end, that free escape in case of fire may always be made. 
For the want of this necessary precaution many patients have lost their 
lives in the numerous fires that have occurred in the last few years in 
our own country. We ourselves have had two fires at Stockton within 
the last fifteen months, but fortunately not in the asylum wards. In the 
first instance the laundry was burned, and in the last an outhouse used 
as a hayshed, and had the wind been from a different direction the 
wooden cottages in which patients are kept might have been consumed 
with the rest. 

We learn, too, that the private asylum of Doctor Chipley, near Lex- 
ington, Kentucky, has just been destroyed by fire. This admonishes us 
that we cannot guard with too much care against the danger and rava- 
ges of this fearful and devouring element. 

Our views with regard to the kitchen, chapel, laundry, airing courts, 
etc., are in entire accord with those expressed by Doctor Manning, as 
previously noticed in this report. It is therefore unnecessary to sj)eak 
of them here. 

With an asylum of this kind, carefully watched during its construc- 
tion that the endless details from a closet to a doorlock may neither be 
overlooked nor neglected, and so located as to possess all the advantages 
we have pointed out, the most favorable results may reasonably be 
expected. And if in addition to this we could only have a small asylum 
for the treatment of such of our citizens as may desire better accommo- 
dations than the State can afford to give, our system would be as near 
perfect as any in the world. There would then be no jealousies on the 
part of the poor, and no complaints on the part of those who pay. The 
rich would have such accommodations as they desired and were disposed 
to pay for at non-speculative rates, and the poor would be as comfort* 
ably provided for as in any other country. As already stated, we can 
scarcely hope that provision will be made for the execution of this last 
suggestion at the present time. The others are absolute necessities, 
requiring immediate action or disastrous consequences, while this is only 
a desirable end devoutly to t>e wished for but not of absolute and press- 
ing necessity. 






CONCLUDING EEMAEKS. 

In our introductory chapter we expressed our obligations to all who 
had contributed to our stock of information or facilitated our investiga- 
tions. We feel that something more than this is due from us, not only 
for courtesies extended in consequence of our position as an officer of 
the State of California, but for individual acts of kindness. 



229 § 

The Commissioners in Lunacy for England and Wales, and especially 
Mr. Wilkes, in addition to valuable contributions for the State Library, 
gave us information that greatly aided us in our investigations. Doctor 
Mandsley, the President of the Medico-Psychological Association of 
Great Britain, kindly invited us to attend the annual meeting of that 
body, and thereby brought us in contact with a large numfcer of the 
most able and learned men in the country, and enabled us to exchange 
views with and obtain the exj>erience of such men as Doctor Bucknill, 
the accomplished author and Chancery Commissioner in Lunacy; Doctor 
Lockhart Robertson, also a Chancery Commissioner, and editor of the 
Journal of Mental Science; Doctor Tuke, the Secretary of the Associa- 
tion, and Doctors Arlidge, Blandf'ord, Sankey, Hood, Monroe, Clouston, 
and others whose writings are familiar to the profession in this country, 
and a large number of Superintendents of asylums from all parts of the 
kingdom. Many of these we had seen, or afterwards visited at the asy- 
lums under their management. Doctor Brushfield, at Brookwood; Doctor 
Begley, at Hanwell; Hoctor Marshall, at Colney Hatch; Doctor Ehys 
Williams, at Bethlem; Doctor S. W. D. Williams, at Hay ward's Heath; 
and that noble trio of genial gentlemen, Doctors Yellowlees, Clouston, 
and Eogers, who reminded us so forcibly of three young Superintendents 
in our own country — Doctors Eodman of Hopkinsville, Kentucky, Cal- 
lender of Tennessee, and Walker of Boston. Doctor Forbes Winslow 
did not attend the meeting of the Association, but we had the pleasure 
of seeing him at his own home. He is a man of such versatility of 
genius and such a fund of knowledge that to be in his presence is to 
imbibe information. We are under many obligations to him. A host of 
others were equally kind and hospitable, and to whom we gratefully 
tender our thanks. 

In Scotland, our obligations are due to Sir James Coxe, one of the 
Commissioners in Lunacy, and President of the Medico-Psychological 
Association, for courteous attention and valuable reports. To Doctor 
Sibbald, Deputy Commissioner in Lunacy, for devoting an entire day in 
visiting with us the Colony of Kennoway, where insane persons are 
kept in private dwellings, after the fashion of Gheel in Belgium; and 
also for a copy of his essay on the cottage system, Doctor Mitchell's 
treatise on the insane in private dwellings, and other documents. To 
Doctor David Skae, the celebrated Superintendent of the Morningside 
Asylum, for giving us the results of his treatment in some cases of 
insanity, together with the effects of certain remedies elsewhere consid- 
ered; and to the Superintendents of all the asylums visited, for similar 
favors. 

Doctor Stewart, of the Belfast Asylum in Ireland; Doctor Lalor, of 
the Richmond Asylum at Dublin; Doctor Murphy, at Killarney; Doctor 
Nugent, one of the Inspectors of Asylums, and other gentlemen engaged 
in the specialty, also placed us under obligations. 

In France, to Doctor Blanche of Passy; Doctor Lasegue, President of 
the Medico-Psychological Society of France; Doctor Motet, the Secre- 
tary of the^Society; and to Doctors Falret, Dumesniel, Morel, Foville, 
Dagonet, Labitte, Arthaud, Carrier, Bruno, Hildebrand, and Ceilleux, we 
are indebted for many courtesies and all the information we were able 
to obtain of the condition and treatment of the insane in that country. 

In Italy, Doctor Fidele, of Eome, not only accompanied us to the asy- 
lum but to the numerous hospitals and other charitable institutions of 
the Imperial City, and gave us letters to several of the prominent phy- 
sicians throughout the kingdom. Professor Neri of Perugia, whose 



# 230 

asylum overlooks the broad Valley of the Tiber, gave us the only 
general statistics that we were able to obtain in Italy, and was not only 
well versed in psychological medicine, but was imparting his information 
to a class of twenty medical students who were studying the diseases of 
the brain that affect the mind. Doctor Cardini, of Florence; Doctor 
Fouscartfof Bologna; Doctor Biffi, of Milan; Doctor Salerio, of Venice; 
Doctor Bramanti, of Padua, and, indeed, all the physicians and Superin- 
tendents whose asylums we visited cheerfully opened to us the doors of 
their institutions and aided us in every possible manner in the prosecu- 
tion of our inquiries. 

Nor can we say less than this of the Superintendents of the asylums 
in Bavaria, in Austria, in Prussia, and in other German States, in Swit- 
zerland, in Holland, and in Belgium. 

Nor can we forget the services rendered us in our visits to the German 
and Swiss asylums by our young and accomplished countryman, Doctor 
B. B. Kent of Boston, who accompanied us to a dozen institutions, and 
from his knowledge of medicine and of the German language added 
greatly to the interest and pleasure of our investigations and our travels. 

To the United States Ministers, Mr. Marsh, in Italy; Mr. Jay, in Aus- 
tria; Mr. Bancroft, in Prussia; Mr. Washburne, in France; Mr. Jones, in 
Belgium; and the acting representative of our Government in England, 
Mr. Moran ; and to the Consuls of the United States, wherever and when- 
ever called upon, we are indebted for favors of various kinds. They 
were ever ready to assist us in our investigations in every possible way. 

It is scarcely necessary for us to say more of the Superintendents in 
the United States than that they are all intelligent men, devoted to the 
cause of humanity, and equal in every respect to those of any other 
country. Among them are men of worldwide rejmtation, such as Doc- 
tors Bay, Jarvis, Earle, Gray, Butler, Kirkbride, Stribbling, Nichols, 
Bancroft, Bead, Buttolph, Gundry, Curwen, and Workman and others are 
well known in our own country. To all of these gentlemen we owe and 
herewith tender our thanks; and to our friend, Doctor Edward Jarvis, 
who not only gave us free access to his splendid library, but who ren- 
dered us invaluable assistance in various w T ays. He is a faithful worker 
in the harness of humanity, and deserves the gratitude of the human 
race. There are many others to whom we are indebted for counsel, 
assistance, and good cheer, and to these, with the rest, w T e offer our 
thanks. If there is any one man in this State who more than any other 
is entitled to the gratitude of the unfortunate class of our citizens in 
whose behalf we have pleaded, that man is our friend Colonel E. J. 
Lewis of Tehama, who, sympathizing with their misfortunes and com- 
prehending their sad condition, introduced the bill authorizing this 
inquiry in order that public attention might be directed to their necessi- 
ties and relief. 



APPENDICES. 



[Appendix A.] 



UNITED STATES. 
Table 1. 



Showing admissions, with principal causes of Insanity, and per cent of each 
to admissions, in twenty -six Asylums, in eighteen hundred and sixty -nine. 



In five thousand three hundred and fourteen admissions, the 
principal causes of insanity were: 

111 health and physical disease 

Spermatorrhoea 

Domestic troubles 

Intemperance 

Religious excitement 

Epilepsy 

Per cent of each on number of admissions: 

111 health 

Spermatorrhoea 

Domestic troubles 

Intemperance 

Eeligious excitement 

Epilepsy 



1486 
708 
544 
544 
527 
357 



^7.96 

13.32 

10.23 

10.23 

9.91 

6.71 



Showing, also, the Deaths, with principal causes, and per cent of each to total 
Deaths, in twenty-seven Asylums, in eighteen hundred and sixty-nine. 



In one thousand and seven deaths, the principal causes of death 
tv ere: 

Disease of the lungs 

Paralysis 

Exhaustion, from different causes 

Mania 

Marasmus 

Old age 

Per cent of each on number of deaths: 

Disease of lungs 

Paralysis 

Exhaustion 

Mania 

Marasmus 

Old a^e 



162 

111 

107 

51 

40 

38 



16.08 

11.02 

10.62 

5.06 

3.97 

3.77 



30 



234 



Cost of Maintenance. 



Number of Patients. 



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o b- . 




o . 




o »o 


; Oq rH 




^ t- : 

CO Oq ; 




00 ' 




rH oq 

r-i r-i 


: co rti 
: <^ 


Proportion per cent of 


OS i—l ' 




r-i 




LO rH 


'■ co oq 


Cures on number 


o o5 : 




iO • 




CO CO 


: oo co 




co th : 

r-i ; 




CO 




CO CO 

rH oq 


: o o 

; T)H rH 


Proportion per cent of 


rH <M ! 




CO 




CO b- 


• C5 O 


Cures on number 


co co : 




CO 




CO r-i 


: oq co 




rH CO ; 




CO 

oq 




ai co 
oq ^ 


; co oq 






b- ■ 




b- b- 


oq uo 


• r-i lO 


Number Kemaining... 




rH*" ; 




CO o 
oq r-t 




: t*h oq 
: ^ 




O CO 


rH O 


CO rH 


: oq o 


Numbftr Diprl 


CO o 

rH 




oq oq 


b- lO 


CO 










b- r-i 




O CO 


O b- 


: CO o 


Numbpr rinrprl 


r-i oq 
Oq 




oq ^ 


r-( CC 
OT rH 


: co b- 






; 






Oi <M 




b- b- 


tjh oq 


: CO CO 






t- 00 




o b- 


r-i c: 


. Oi !>• 




Total 


Oq tH 




co oq 


. r_l *> 


CO 


H3 




r-i 






. r-i 




a> 














-t-s 


















r-i -H 






o 




-+ 


: oq 




H 




CO b- 






CO 




a 


: th 




u 




r-i rfi 










CC 


; 













































3 




















£ 


Male 


148 
1,108 






CO 
CO 




CC 

© 
-r 


• r-i 






co oq 




O CO 


'■ CO iC. 


: oq oc 




Number Admitted.... 


00 CO 




' b- ^ 

r-i 


: o © 
: i> Tt 


: co 'H 




rHOOtOOTOOCOb- 


00 r-i O 




05(MrHCNC0C0(MO0C 
rH Ci NHM^« 


Ci CO CO 
CO -^ 
















: C 


> 
























. b- 
























. Oi 










• 














. CO 










GO. 














: oo 










B 














■ rH 










t> 






cS 






; -n 




c3 






Hi 






0-2 P 


: <$ 


'- 


Is 






a) 






HH O P ^^ 


o 

M 


V-^i 




<4 


E 

r— 
< 


11 

c 

! 4- 

r= 


* 

I. 

et 
< 


g 

1 

c 

c 




i p 

c 

IIS 


c 

?- 
.c 

+: 

H 


> c 

a 
c 

1 — 


c 
hi 


1 

P 
M 


Mt. Pleasant, 
Kansas 


H- 

C 

c 

+a 

'=J 

a 
hi 






243 



CO 

t> 

CO 


: m : 

. OS . 

: *• : 


■^(MHCON^ONMMHkO • 
t>-^O"^Q(Mi©r|J!MC0H0Q . 

i>^o6i6i6o6c6^c6o6rHrHi6 : 
t— i t— i : 


©q 

GO 


1—1 
I- 

OS 

1—1 


: ^ : 
: oo : 
: °^ : 


OCOCOCOOsOCO^OOt-COO '• 
O'OHM^OH'O^'OCOO ; 

©It— IHHH^r 1 r- It— 1 NH ; 


O 
£-; 

CO 

©q 


©q 


: oo : 
: t- : 
: ©q : 


OOONt> ' 

o l- t- ©q : 

o o ^ oo : 


rH ^h th t- ©q co ©q 

m io co tr- t- co ©q : 

oo ©i t^ cd os co os : 

rH t— 1 rH r-i ; 


CO 
rH 


©q 

o 
oc 
cc 


: ©q 

: os 

'. CO 


CO rfi CO iO 
COH00N 

rH t-5 os -HH 


rH t- CO CO CO CO CO 
£- £~ OS lO O iO CO 
lO rH OS lT3 GO O lO 

©q th ©q co o co ©i 


rH 
00 




■ )0 

: co 




os ©q to 

O CO o 
-H CO T)H 


CO 00 iO CO O CO CO 

MhOOOOiO 

©q rH co ©q rH co ©q 


' ©1 

: <** 


H- 

1— 


: co 


■^^oococo©i©qcoiocO"^oo 

.©qCOC0C0T}H-<HrH^H©q t- rH 


: ©q 

. CO 


©q 


: 00 

: "* 


: ©q co ©q o 

■ COiOHlQ 
; rH rH 


: !>COHHCOHH 
'. ©1 CO OS ta rH OS CO 


: co 


©q 
tr- 


: b- 

: co 


: oooo^oi>mco^iflcoco 

;COI>J>COi©o:M»OCOHCOm 


' 00 

: co 

; CO 




: CO 

: ^ 
: ^ 


: i— i co co co 


1>CO>OHO 
TP CO CO 00 OS 
, r-i r-i ©q 


CO 

OS 
rH 


: co 
: os 




. : ©q 
: : ^ 


: CO CD 00 t- 
: CO 00 CO lO 

: i—i co co ©i 


' O O CO 

: t- co t> 

• rH rH ©1 


OS 


00 
CO 
rH 


: ©q 

: os 

; rH 


T- 


i '• o 

► '. CO 

• T— ( 


''OTtii0©TC0i005-t | C0i— IG0O 

:N00NOC0OI>H^C0G5N 

• i— i co co ©q ©q i— i coh nh 


: co 

■ rH 



rHC0fc~^OCDC0©qt-©q^0SrH'*00C0OC0 
OCOCOrHOSt-GOOCOrHOO©qCOlOCOi— ILOlO 
C0rHC0rHrHCOC0^©q©lrH©qrHrHCO©qCq©l 



M 

® r* 
o § 

W4 



2^ 



+3 

o3 

© 

© 



:« :-> 



co d 
d.d 

d c3 



rH 

o ^ 



W 



CD 
GO 
03 00 

M so 
-^ 

PH rH "*d 

d~£ * 



OS 
CO 
00 



GO rd 

CO O 

C3 ^3 d 



o 



ro^i 



p==i^ 



o ^ 

S3 f-i 
c3 © 

^ r^ H £ H PQ 02 W QQ 



O c3 

d += 
d ^ 



°? ^ c 

r^ O £ 



d 

o 

CD 
H5^ 



o 

- d fH 

© 

|.s 

hh!> 






o 
© 

d 
+Jh o 



244 



Zfl 

< 
zn 

P 
i— i 
P 



73 

• I— ( 


o 
O 



rH 

W 



O 

oo 



g 

«0 



.CO 
05 



Proportion per cent of 
Deaths on number 
treated 

Proportion per cent of 
Deaths on number 
admitted 

Proportion per cent of 
Cures on number 
treated 

Proportion per cent of 
Cures on number 
admitted 



Number Eemaining.. 



Number Died. 



Number Cured. 



r& 



05 



Total. 



Female. 



Male. 



Number Admitted. 



Number Kesident 



co 
i-l 

< 



OHWOi 
rH 05 00 lO 

id co t^ co 



rH C5 <M TJH 

OOlOHCO 

r- 1 r- I ©q r- 1 






COOH 
lOOOO 



©q 



©q co ©q co 



00 
rH 
CD 



©q lO 

CO tH 



Tfl ifl lO 1> 

rH t- £- ©q 



OOiflCOO 
CO lO O CO 



rH rH b- rH 

H 00 lO H 
00 O Oi CO 



OC5N 
CO CO CO 

tH »o o 



t)<iOO 
OO^Oi 
CO iO CO 



t- rH lO CO 

tHOOiOO 
(MtHCCH 



CO 

CO 



©q 

Ci 

CO 



©q 



©q 



©1 

CO 



©q 
©q 



o 

OS 

00 



o 

CO 



co 

rH 



GO 

CO 

CO 



CO 

©q 



OS 

b- 

rH 



©q 

CO 

©q 



-H 



CO 



C5 

o 

CO 



b- 



N "* LO H H O 
H ^ iO iQ lOOJ 

CO rH CO rH rH b^ 



rH CO rH tH lO t-h 

CO 00 rH C5 CO b- 



b- co ©q 

rH CO 



co ©q 

©q 



b- CO b- CO rH rH 

co »o co ©i ©q o 

OJlflNOHH 

rH ©q ©q ©q 



rH CO CO CO rH CO 
C5 rH tH CO CO rJH 

©q C5 rH CO C5 o 

o ©q ©q io co co 



NOQH 
00 CO O rH 

©q co iO *o 



CO co OS co rH ©q 
©q co co 



OS rH CO CO O iO 

©q o co co 



CO lO CO C5 CO rH 
OS oo »o O lO 00 



iO ©q O rH 

©q CO Ci 00 
rH ©q CO CO 



00NC0O 

©q rH co o 
rH ©q co rH 



b- ©q co co b- co 

h h n a o h 

rH rH ©q 



t-COrHrHCOOOCr5©qOaSOOlC)COCDrH 
COOOCDGOrHTHOrHCOi>'CO©qrHTtlirH 
lO CO CO rH r- ' rHr-i ©q CO CO iO 



f» 



-H r^03 



PH 



-^ .oT ^ 



J°r3 



HfH 



.^^r-s 



Sfc*i 



fc 






pa 



rH t> P3 



£ rd 






•r-< 

bJ3 



c3 O 



Hp^pq^pqfHEHOpq<!OpH^pHl 



245 



oo a co Ci rH co 


• o 


Ol 




CO CO C7i CO CO rH 


CO 


1 rH 




N O CO N b- b- 


'. r-i CO 




fOiOCOfONOb; 


**~i 


Ci CO 00 OO CO CO 


| O OS 




CO CM CO 00 JO CO CO 


1 "fr" 

i 

1 


N O N CO H 'O 


* rH rH 




CO 00 CO 00 CO rH 00 


CO 


rH rtj CM 00 CM CO 


•. 00 rH 




00 JO O CO CO O CO 


o 


CO CO rH CO 00 CO 


: rH rH 




CO d CM oo oo ci cm' 


CO 


H H (M CM r- 1 


: rH CO 




OO CM rH CO rH CM 


r-i 


OOOOOOOb- 


: ?£> i>. 




rfl tO CO CO >0 CO CM 


o 


rH CO C5 O0 rH CO 


I rH O 




O O b- OO O C5 b- 


<Ji 


n co c4 cd »o d 


I rH 00 




O CO CO OO CO C5 O 


CM 


t— 1 r-i rH r- 1 r-i 


; rH 






r-i 


00 rH OO CO O CM 


• b- CO 




CO CO CO O Oi rH b- 


r-i 


N q co co oo co 


: os co 




rH rH O rH O iO rH 


CO 


rH CD O rH b-"- CD 


: i-A co 




Oi O rH >0 CO rH CM 


CM 


CO CO CO "f rH CM 


I rH CM 




CM 00 rH CO 00 OO 


CO 


CM rH : 


(M^H 


• O O 




COffiiOOb-O '• 


CO 


cm rn : 


CO CO O 


: Ci rf< 




rH O 00 O O CO I 


o 


i-i co : 


Tfl rH 


: ^ 




O CM CO rH CM oo : 


cm" 

r-i 


NiOHCOQOO 


: CM rH 




O t- 00 O rH CM rH 


r-i 


HMO CO CO 


; rH CO 




rH rH rH rH CO rH 


O . 


T— 1 








CO 

T-T 


N tH J> lO O O 


: -^ co 




O CM CO CO CO CO OO 


b- 


CO OS rH t— I CO co 


: co cm 




00 CM CM rH O CO 


o 


r- 1 








CO 

oo" 


CO^OIHCOM 


: O CM 




rH OO 00 O rH CM 0C 


rtH 


00 t- CO Ci t- co 


: co cm 




00 1- 00 00 rH 00 rf 


CO 


HlflH lO O 


: cm co 




CO CM CO rH CM O CO 


°i. 


i-T 








CM 




O 


o : 


b- 


: co : 




MCOHiOOOiON 


l : 






b- 


o : 


■70 


'. rH '. 




O rH t- C5 CM CO O 


i 






CM 




CM 


*. rH : 




CO rH rH rH CM r- 


; 






OS 


' T— 1 


lO 


: CM CM 


; 


cooNiacoNr- 








C5 


. "* 


CM 


: cm co 


I 


CM OO rH CO rH (O C: 


< 






CM 




CO 


; rH 




O0 rH CM rH CM rt 


j 




<M rH CO CO GO 00 


•' rH C 


• 


' O 00 Oi O CM 00 rt 


CTi 


C5 CO r- 1 CO CO CM 


: co c: 


! 


CM t- O rH rH CO CT 


CM 


CM r^ rH CM 






r-i r-i r-i r- 


1 CM 

o" 

rH 


HCOCO^O^ 


O rH CN 


rHOOrHOrHOCMrHrt 


1 

i iO 


Oi'rH CM O tH CO 


CM O CO 


ffi^HOfMbOCOif 


5 OO 


Mb- -^ CO 


r-i CN 


CM lO CM CO CM CO ^ 


i b^ 
b-" 

rH 






































■ °3 e3 
































• r-l © 

: o rjC 














n 


i 






. C 


) 




C 

F 

c 

t 
< 

P 


• ^ c 

3 c8 c 

hPhP 


3 

■1 OS 

■«P- 
□ 

H P 


p 


i 

<A 

3 P 

2 C 

H E 

1P 


I r- 

. dp: 
»Pm 
< - i 

rx CD C 

> >■ "c 

■1 i-H K 

\r<£ 


| c 

11 

► - 

i c 


2 ^H 

I A'* 


: ^ 

i> 

i 

i c 

> r- 

11 

•4P 


i 

r & 

11 

5 a 


c- 

|| 

: 5 


: c 

5 r 

IS 

at* 


- +^ 

•I 

1& 


> 

2 Of 

!! 


! 

f] 


i 

1 1 

Q 

a 


2 

s 

> 



246 

CANADA. 
Table 5. 





tzj 


> < 


3 1 


3i 


tz{ 


^d 


3 


*d 


Hd 


( 
; 


5 & 
IB 


Zu 

3 : 


I \ 


D 

2j 






M 4 t 




o o 


( 
ASYLUMS. 


^o 4 

t> CD 

rt- 
O 


■D 
2j 


3j 




3 

c-t- 


is 

/J e-t- 

2.5* 

1 o 
o 


*?. ! 

>-s o 

CD h+j < 


a O 

o 3 
c 

5*o 


p ° 

r§ 

CD 




p 








pj 


£ 


CD C 


Pj 


- pj 


\ 












4 


^3 


CD 


E?" © 




cd 










CD 
CO 


: co 




CD X 














e+ 


• rt- 


i->' 


: t^ 




co 










O 


: o 


CO 


: co 


1869. 






















216 

518 
238 11 


'9 J 

•7 J 
50 ( 


53 ] 
55 i 
32 J 


L3 
26 

50 


295 
595 
368 


41 
45 
47 


11 

5 
16 


16 
33 

23 


4 




4 


Provincial Asylum, Frederickton 


8 




31 i 


25 ] 


L7 


2 


66 


68 


30 


8 


3 


1870. 






245 

509 li 
239 12 


ro s 

21 < 

24 ' 


16 J 

14 J 


25 
$7 

56 


315 

630 
363 


84 

38 
35 


7 

7 

12 


35 
30 
29 


7 




5 


Provincial Asylum, Frederickton 


9 



247 



P 



P 

<1 







Average capacity 


NXHHO 
rH Tft CO CO — i 


CO 
CO 








1 






of Asylums 


LOH CM 


r-{ 








M 






OCOCOlOO 


^ 




i- i-{ : 


CM 


0B 








C5 i— 1 C5 00 CO 


rH 




o co • 


QO 


r- 






Total 


iO cm "# CI CO 


C5 




COCO • 


O 


CO 








'tcqiMH 


rH 




o co : ! 


OS 


GO 








<N 


CO 




rH ; 


-*< 


rj 














: i 




"-3 




. 




■* -*Tt< CO • 


CO 




i^CO • 


CO 


c 




i> 




t— 1-* y- i co : 


OS 




O CO . 


■>* 


aC 






Pauper patients 


co^co o co : 


C5_ 

lo" 




co^o_ : 
cTco" : 


cm" 


-•-> 








<n ; 


cq 




rH ; 


-* 


S 

<3 
O 






OMOOO 


CO 




: co : 


Oi 


CD 








rH -h^ t~ rt< co 


rH 




: cm : 


CO 


a 








cm oq_io_co_ce 

r-Tr-Tr-T 






: oq : 


co" 


^3 




Number of Asy- 


GO lO i— 1 CO CO 


o 








>-. 






lums 


-7f< rH rH CO 


rH 








-+j 






.^ 






Average capacity 


Moomc 

CO rH !>• CO CC 


CO 

cq 








m 






of Asylums 


CO iH r- 


T—i 
















1 








CO 








C5 rH b- CO C~ 


•* 




or- ; 


1—i 










O CO N OS t^ 


<* 




o •* : 


Ol 








Total 


o; w o o r- 


co_ 




oo^co_ : 
co"ifi" ." 


co" 


.r3 














r-i 


cq 






CO 


0D 

o 










































OlOCiN 


t~ 




O l- • 


■* 


oi 








C5 t— Ci CO 


lO 




o ci : 


IC 


T3 




00 


Pauper patients 




GO 

co" 




oq^ : 
co"tfT '. 


co"" 


o 

B 




rH 




rH 


1—1 






CM 










1 








o 








co co C5 r-i cr 


t- 




:© : 


w 


o 

CD 








h ic n h ?; 


GO 




• o • 


CO 






Private patients.... 


(NlCO^lOr- 
r-TrH r-T 


CO 




: >-h : 


00^ 

^" 


'cl 


rH 
















S 1 


l_3 


Number of Asy- 


N O N a r 


os 











pq 




lums 


CO rH CO l^ 


CO 
rH 














p£ 




Average capacity 


HHHCC< 

co o co ^ cc 


C5 
















IMH CN 














co h n n c: 


cq 




1> lOCSJ 


CO 


OD 

n3 








GO rH CO CO C 


CO 




OS lO CO 


7—( 








Total 


•"*! r-H-- CO CC 


GO 




1^00 


lO 


> 








OH(MCO 


co" 

rH 




I>T}< 


co" 

CM 


CD 








N ■* i* N C 


^ 




t^oo : 


: 


CD 




00 




^00 CO CO tJ 


CO 




o i-h : 






Pauper patients 


Pica cq^co^r- 

lO" rH~Cq~ 


<cT 








o 




1-H 














cs 

"5 
























C5 t— CO O CC 


lO 




: b- : 




c 








CO CM O CO C£ 


CO 




• CO • 










CM 1- rH^LO^Tt 
r-Tr-T 


< o 




: ^ : 




p« 

CD 
rj 

OS 




Number of Asy- 


rH rH lO O O" 


> CO 








1= 








(MH^O 


















rC 
































-»-3 






CO 

n 


co • 

© : 










o 








2 « t 


o < 








-t-i 








-j © i 
















>> 


O cc S 




t? 






C/ 






CO 

< 

QJ3— 


rH Cr - 


2 


5? 

0J 


• CO • 

:^5 : 
: o : 


Ji 


CD 
CD 

c 






and Boroi 
ed Hospit 
litan Lice 
ial Licens 


5 'c 


o 


khouses... 
latives or 


CD 

PI 

S3 

:/) 



l-H 


|>TfH 






fe^&g' 


* 1 


> 53 


f-. <£ co 
O r<^J 


o 


QO Ph 








~g^ 

B'l 

o o 


«■§ gr 

3r3^< 


5 


' 1 


In W 

With 
In Ja 


EH 


O CD 
M > 

m 



248 



00 



o 

00 





^8 




<» 




•w 


cq 




H 


co 


in" 


g 


M 




-< 


CO 


EH 


^ 




< 




CO 








r-o 




5» 




^ 




^ 




'K 




o 




CO 




to 







Per cent of Deaths 
on No. Treated.... 



Per cent of Deaths 
on Admissions 



Per cent of Cures- on 
Number Treated.. 



Per cent of Cures on 
Admissions 



Numbers Died. 



Numbers Cured. 



Numbers Treated 



Numbers Admitted. 



Total. 



Pemales 



Males. 



m 
< 



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r-t 

o 

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32 



250 



P 
P 



CO 

M 



EH 

O 

EH 


Total 


CO 

CO 


10,090 
1,372 


11,462 

47,375 

3,955 

2,759 

3,790 

10,504 

36,871 

13.5 


Females .. 


CO 
CO 

oo" 

1— 1 


CO i—l 
CO CO 


Oi 

co^ 


2,172 

1,298 
1,683 
5,153 


: fr- 


Males 


00 

CM 

rH 


H^ 1—1 
OJ HH 

i—l CO 


co 
b^ 

10" 


1,783 

1,461 
2,107 
5,351 


> OJ 


P5 
H 

Ph 


Total 


cq 
oq 

°^ 
of 
<m 






















Females .. 


oq 

CO 

oq^ 

co" 

rH 
























• 

o 
co 
t^ 

co" 
rH 






















EH 
H 

Ph 
Ph 


Total 


1—1 

oq 






















Females .. 


CO 
Ol 

CO 

of 
























00 
Oi 
oq^ 

co" 


























as 

co 

00 

1—1 

T-T 

CO 

6 

CD 

P 
a> 

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o3 
PM 

<+H 

o 

CD 
rO 

ft 
* 


ct 

E 

• r— 

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+i 

ae 

*• 

r- 

a 

■+: 

-r= 

'£ 

< 


• 

: 


> 

• 


r— ■ 

■+: 

C 


H-3 
P 

CD 

£ 

+= 

c 

r-l 
+= 

rH 

CD 

^C 
P 
P 

rH 
CC 

rC 

f 

r- 

K 

H^ 

c 
E- 


*6 
g 

Si 

•r- 
P 


1 ■ 

S : 

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o : 

p : 

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c3 : 

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CD ' 

2 : 

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a 

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CD 

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c3 > 

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p 


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P 


cc 

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rr 

c 
b 

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ci 

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c 

'ci 
C 


o 
fr- 
ee 

r^ 
r-i 

CO 

e 

CD 
P 

F 

'p 

°1 

c 

s 


Proportion per cent of readmissions 





251 

ENGLAND. 
Table 3 — Continued. 





Males. 


.Females. 


Total. 


Proportion per cent of recoveries to admis- 
sions 


30. 


38. 


34. 


Proportion per cent of recoveries to numbers 
tr eat e d 


8.3 


Proportion per cent of deaths to admissions. 

Proportion per cent of deaths to numbers 

treated #. 


36.5 


29.5 


33. 

8. 


1871. 
Proportion of pauper lunatics to total pau- 
pers 






4.63 


Proportion of pauper lunatics in asylums 
and workhouses 






85.43 


Proportion of lunatics maintained by rela- 
tives and others , 






14.57 











Fifty-four English asylums made postmortem examinations in thirteen 
hundred and fifty -two cases, out of thirty-one hundred and thirty -five 
deaths, in the year eighteen hundred and seventy. 



252 



ENGLAND. 

Table 4. 

Showing the ratio of total number of Lunatics, Idiots, etc., to population in 
each year from eighteen hundred and sixty-two to eighteen hundred and 
seventy-one, both inclusive; also, number of patients in private houses, and 
number in asylums, workhouses, etc. 





^ 


i-3 


&d 


Number 


in private 


Number in asylums, 




a 

JO 
e-t- 


otal 
ofluna 
iots, et 
uary 1 


e-t- P 

*& O 

O 


bouses. 


poorbouses, etc. 


YEAR. 












O 


»0 rt-0 


P 




^d 


hj 

Hi 


hi 






: *-*? $ 


Ef". M 


< 


c 


<! 


s 






: p ^.^f 


2 o 


P 


*cs 


P 


►d 


• 






© • 
: o 


cd 


CD 
.4 


CD 


CD 

4 


1862 


20,336,467^ 


41,129 


2.02 


146 


6,157 


5,274 


29,552 


1863 


20,554,137 


43,118 


2.09 


153 


6,405 


5,354 


31,206 


1864 


20,772,308 


44,795 


2.15 


159 


6,541 


5,446 


32,649 


1865 


20,990,946 


45,950 


2.18 


212 


6,557 


5,662 


33,519 


1866 


21,210,020 


47,648 


2.24 


227 


6,580 


5,873 


34,968 


1867 


21,429,508 


49,086 


2.29 


223 


6,638 


5,920 


36,305 


1868 


21,649,377 


51,000 


2.35 


274 


6,829 


5,850 


38,047 


1869 


21,869,607 


53,177 


2.43 


324 


6,987 


5,900 


39,966 


1870 


22,090,163 


54,713 


2.47 


356 


7,086 


5,924 


41,347 


1871 


22,704,108 


56,755 


2.49 

• 


392 


7,331 


6,062 


42,970 



253 

ENGLAND. 

Table 5. 

Showing total number of Paupers and of Pauper Lunatics, Idiots, etc., with 
the proportion per cent of Pauper Lunatics to Paupers, the proportion per 
thousand of Pauper Lunatics to population, and, proportion per one hundred 
thousand of non-Pauper Lunatics to population. 



YEAR. 



O >t3 
P £ 



^ co T5 Z~~ 
._. CD CD 

Mm 4 J 



■5 a 

«H^CD 

§ P ^ 

a £lo 

I 1— HI, 



P O P <rl- 

M CO a p 

P OjCD -> 

4 C4 £ 

o a 



^ 



o p o 



^a s-^a 
Pop 

CD tJ 
£ © CD 



^ 



C5 

3) 

a 
-IT 
a<rc 

E CD 



a - •-< 

s <=\2 

p 2^ 
c 2. 



P 



O 

co ■• s: 

* ^ a 

ef- p P 

o'cd J2 
a sra'a 

• P CD CD 



a M ^ 

a p So 

" o o o 

co O >-i 

o a °w- 

o o 

a ►a 

a? — >a 

i-i a a o 

O I I <-i 



O ' 



p 



1862 
1863 
1864 
1865 
1866 
1867 
1868 
1869 
1870 
1871 



946,166 

1,142,624 

1,011,753 

974,772 

924,813 

963,200 

1,040,103 

1,046,103 

1,083,532 

1,085,661 



35,709 
37,611 
39,190 
40,076 
41,548 
42,943 
44,876 
46,j953 
48,433 
50,301 



3.77 
3.29 
3.87 
4.11 
4.49 
4.45 
4.31 
4.48 
4.46 
4.63 



1.75 

1.82 
1.88 
1.90 
1.95 
2.00 
2.07 
2.14 
2.19 
2.21 



26.6 

26.7 
26.9 
27.9 

28.7 
28.6 
28.3 
28.4 
28.4 
28.4 



From the above we find there is one pauper lunatic to every twenty-two paupers; one 
pauper lunatic to every four hundred and fifty-one of the population, and one non-pauper 
lunatic to every three thousand five hundred and eighteen of the population. 



254 



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256 



ENGLAND. 

Table 8. 

Showing Length of Residence in Sixteen English Asylums of Patients who 
Died therein or were Discharged therefrom Recovered in 1870. 





DIED. 


Discharged Kecovered. 


LENGTH OF RESIDENCE. 


cd" 


o 

B 

CD 
w 


o 

80 


CD 
w 


CD 

3 

SO 
9 


o 
£1 


Under 1 month 


52 

67 
56 
69 
76 
212 


32 
43 
31 
29 
52 
235 


84 

110 

87 

98 
128 
447 


15 
92 
105 
97 
52 
38 


10 
81 
182 
139 
53 
54 


25 


Over 1 and under 3 months ... 
Over 3 and under 6 months ... 
Over 6 and under 12 months... 

Two vears and over 


173 

287 

236 

105 

92 


*/ 




Totals 


532 


422 


954 


399 


519 


918 







Table 9. 

Showing Proportion per cent of Numbers Died and Discharged Recovered 
the following periods to the whole Number Died and Discharged Recovered. 



Under 1 month 


8.80 
11.53 

9.11 
10.27 
13.42 
46.86 


2.72 
18.84 
31.26 
25.70 
11.43 
10.02 


£ \ 




Over 1 and under 3 months 




Over 3 and under 6 months 


PI 

o 


^7«.55 


Over 6 and under 12 months 




Over 1 and under 2 years 


J 

||} 21.45 


Two vears and over 


«/ 


Total 






100.00 













257 
ENGLAND. 

Table 10. 

Showing Numbers Resident, Admitted, Treated, Discharged, Died, and Re- 
maining; also Proportion per cent of Recoveries and of Deaths to Admis- 
sions/or Ten Years, 1861-1870. 



PATIENTS. 



Number; 











*-i «rf- 




S o 




n-» 








>3 




P^ 




3 ° 




t a 



o5 

5 O 



Numbers resident January 1st, 1861 24,989 

Admitted ■ 101,927 

Treated 126,916 

Discharged cured 34,716 

Discharged not cured 22,826 

Died 32,087 

Total discharged and died 89,629 

Remaining 37,287 



34.05 



27.3 



SCOTLAND. 

Table 11. 

Showing number of Patients resident, number treated, admissions, recoveries, 
and deaths, with proportion of the recoveries and of the deaths to the admis- 
sions and to the number treated in the Lunatic Asylums visited in the year 
eighteen hundred and seventy-one. 



ASYLUMS. 



fcj 


z 














B 


_) 


& 


^7* 


o 


B 


*-i 


-i 1 




a 


O 


Zu 


r/3 








Pi 

O 


rjf 


Ej 


T> 




-<- 


^ 1 



CD 



CJ 



^ 



Proport'n pr 
centum of 
recover's to 



Proport'n pr 
centum of 
deaths to 



5 



P 






> 

&■ 






o 

4 



Eoyal Edinburgh. 
Eife and Kinross... 
Dundee Eoyal...... 

Inverness District. 

Stirling District 

Glasgow Eoyal 



Total. 



754 
227 
190 
279 



545 



1,995 



265 
70 
59 
58 

252 
326 



1,019 
297 
249 
337 
252 
871 



118 
35 
25 
26 
14 

147 



1,030 3025 365 



67 
13 
13 
26 
16 
71 



206 



44.52 


25.28 


11,57 


50.00 


18.57 


11.78 


42.37 


22.03 


10.04 


44.82 


7.71 


44.82 


5.55 


6.34 


5.55 


45.09 


21.77 


16.87 


35.05 


12.06 


20.03 



6.57 
4.37 
5.22 
7.71 
6.34 
8.15 



6.80 



33 



258 



* 



P 

EH 
O 
O 



© 

t^- 
OO 



Q 

£ 






so 



o 
CJ 

CO 



co 
CO 

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m 


CO 




g 


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73 


H 


^ 



to 

•fO 

c<T 
o 



hi 



to 

si 



to 

I 






Total 



Females 



Males. 



Total 



Females 



Males. 



Total. 



Females 



Males. 



m 

i— i 
En 

< 



HCOrHNHHO 
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CO © © © 
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75 
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CD 
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75 

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259 



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£ 


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1-3 o 



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03 



02 

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Total 



Females .. 



Males 



Total 



Females .. 



Males 



Total 



Females .. 



Males 



Total 



Females 



Males 



Total 



Females 



Males 



oo coco noiH 

CD lO -* O Tt< 

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h<^ cm go no 

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LO 



CO coco t^ CO 
CO rf !>• -* CO 
CO tH 



CO 



CM CO © UO CO 

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CM rH 



CO I- 



CS) 00 © CO 1— 
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CM iH 



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CO HO y-t CO CO 
CO CM CO uO © • 

tJH no CO tH CO SS 



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cm' 



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rJH CM ^H ■* © 
CM 00 CO CM iH 



CO 



CM 



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00 



co cq 

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CM no t>- CO ^ I~- CO 

CO T* co© ** 
COCM iH 



CO cq 



CO 
CO 



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csjcocmcsicm r* rj co 

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CM 



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g 

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02 



03 
ft 

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co 05 > 

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260 



SCOTLAND. 

Table 14. 

The ratio per one thousand of the total number of Lunatics, Idiots, and persons 
of unsound mind, to the population in each year from eighteen hundred and 
sixty-two to eighteen hundred and seventy-one, both inclusive. 



TEAR. 



hi 
o 
►d 
c 


Total nu 
lunatic 
etc., Ja 


» o <*■ 
d" B '-" 

a'di o 

3g? 


8# 


Number in Asylums and 
Poorhouses. 


P+- 






p 


mbe 
s, id 
nuai 


2* 


CP5 B* 

tn p 

: d 




C 






"d ,-> 
o 2 

1 <X> 


: <! 
: f° 

: ri- 

: ^ 




d 


3,083,989 


6,341 


2.05 


1,741 


1,031 


3,548 


3,101,345 


6,327 


2.04 


1,679 


1,023 


3,604 


3,118,701 


6,359 


2.03 


1,637 


1,018 


3,683 


3,136,957 


6,468 


2.06 


1,609 


1,055 


3,783 


3,153,413 


6,616 


2.09 


1,568 


1,104 


3,922 


3,170,769 


6,762 


2.13 


1,548 


1,143 


4,046 


3,188,125 


6,931 


2.17 


1,521 


1,158 


4,224 


3,205,481 


7,157 


2.23 


1,500 


1,128 


4,494 


3,222,837 


7,409 


2.29 


1,469 


1,163 


4,728 


3,358,613 


7,808 


2.32 


1,430(?) 


1,178 


4,817 






1 to 438 


1 to 2,548 


1 to 2,936 


1 to 697 









1862 
1863 
1864 
1865 
1866 
1867 
1868 
1869 
1870 
1871 



261 



ft 

O 
O 



* 



^3 

.2? i-j 



q 






© 

CO 



CO 



"s-^ 









53 « 




^ 




^ 




o 




"■£ ^ 




?- si 




©> -*=e 




£ S 


lO 


^ 


r-i 


S © 


H 


^ co 


h3 


eo~ § 


W 




< 


« r^> 


H 










« £ 








js's 




© ■«- 








fcu 








~ CD 




*^3 ^ 




co S3 




to <4i 




*3 ►.«- 




bi co 




5^. 




p.8 



s 



§ 


<^3 




to 


CO 




£ 




<o 




CO 


^ 


co 


K 


*cO 


e 




CO 




" — o 


©* 


<*> 


£ 




s 




© 




^ 




CQ 





Pt 



ft *-• 



^ 



P 



« 



a 



a 



H 






Total. 



Female. 



Male. 



Total. 



Female., 



Male. 



Total . 



Female. 



Male. 



Total , 



Female. 



Male. 



Total, 



Female- 



Male. 



Total. 



Female., 



Male- 



Total. 



Female- 



Male. 



Total . 



Female- 



Male. 



CO i— IC5 00 






?i 



•*NN <M 



£q 






85 



oooicq 
ococo 



ooo 
co co B5 
cocooS 



cot- CO 
uooqcq 



i— IIC CO 

ooco 

I>0 r-i 



COOO^f 
i-OiO(M 



18 



M< rfio 
T-ICOiO 



rtiCOlO 00 



NMN r-l 



>nt-t- >-< 

OCOCO i> 



: : to«i_j • 

: to <g © : 

to a a w : 

Sfl ~ to : 

&£, TO t. 58 

PhP^AhP 



o 
H 



262 



A 
ft 
<1 

A 



CO 

s 

r3 

EH 



<5i 



CO 
-Si 

*>3 

'£ s 

^ ."is 

CO 1 

to ' 

§<§ 

^^ 

%s 

■ t<> 
§£ J". 

or Ss. 

<^> <43 



P^ 



CO "^ 

S © 

© -^ 

"S3 tg 

co ^ 

| I 

31 









*© 



©> 



© 



Proportion per cent 
of deaths to num- 
ber treated 



Proportion per cent 
of deaths to admis- 



sions 



Proportion per cent of 
recoveries to num- 
ber treated 



Proportion per cent of 
recoveries to ad- 
missions 



Died.". 



Kecovered. 



Number treated. 



Admissions. 



c3 . 
«M 03 

fn *« 
© 03 
rO ft 



Total 



Females 



Males 



< 
O 

<! 



C3 

id 



Jb; 

00 

CO 



\g 

Oq 



b- 



o 

CM 



CO 
00 



CO 
Oq 



en 

C5 



CO 



CO 1> 00 O CO 

OS rH CO co ci 



or 

CO 



o 
b^ 



tH 


rH o co co oq 


CO 


<M 


CO 

H 


OS C5 CO Oq CO 

oq (Mco 


CO 


rH 

oq 



TH O t+I iG CO CO 

t^h \g ci oq ci ig 



\G 

oq* 



C75 oq oq oq oq 

r^" Jt^ CO Jt^ rH 
TH Oq rH rH CO 



00 
CO 



CO 

b^ 

CO 



oq 



OCiH 

oq t* co 



co 



CO 
iG 

oq 



rH co cs oq o 



b- 



tH C5NCOO 
Oq )0 rH rH oq 
CO iG CO CO 



CO 



CO 

co^ 
co" 



iG 

oq 



oq co ci 

O rH rH 

co oq 



co 
o 
oq 



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o 

b- 



b- 

co 
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co oq t* CO rH 

ocooaici 

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IG 



oq 

CO 



CO CO 
OS r-t 
CO 



t* b- 
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CO r-i 



CO 



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r— i 
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m 



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a 



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t-3 ?H , 1 



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43 23« Op 

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CO 
00 



00 



00 



CO 

CO 






si 



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CO 

to 

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-5 

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C3 



C5-, 






263 
Total .... 



CO 
CO 



Female. 



Male .. 



Total 



CD 
CO 



Female. 



Male 



Total 



CO 



Female. 



Male .. 



Total 



CO 



Female. 



Male .. 



Total 



CO 
CO 



Female. 



Male .. 



CO 



OS -& CO OS 00 tH 
CO CO OS O 90 OS 

oSmoqiOHCS 



OS 



•<*< OS OS CO i-l <N 
lNCOO-*-*m 



CI 

1—1 
co" 



io m -*n co <M os 

CO CO GO CO OS iO 

HQH(N OS 



CO 
Ol 

CO 



T— I 



cq o coos coo 

C<l O *0 UO <N CO 

WOH^HlM 



CO 
OS 



ooiooiio 
co eq cq i-h 



CO 



© "* rH 03 tH iO 
CN CO O lOCO CO 
1- 1^- iH (M O 



CO 
CI 

OS 



CO CO O CO iH lO 
iH OS CO CO OS O 
OS_CO_CN rt< OS 

ofof co" 



CO 

CS 

o 



CO O CO Ol 
CO ""^ CO CO 

OS OS co •* 



co 



o 
o 

Hi 

fQ CD 

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2?£ cs 



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M 
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P. 

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264 



IEELAND. 
Table 18. 

Calculated Population of Ireland from 1841 to 1871. 



Year. 


Population. 


Year. 


Population. 


Year. 


Population. 


*1841 


8,175,124 


*1851 


6,552,385 


*1861 


5,798,967 


1842 


• 7,996,219 


1852 


6,472,830 


1862 


5,728,565 


r 1843 


7,821,253 


1853 


6,394,244 


1863 


5,659,012 


1844 


7,649,920 


1854 


6,316,628 


1864 


5,590,312 


1845 


7,482,687 


1855 


6,239,928 


1865 


5,522,437 


1846 


7,318,985 


1856 


6,164,171 


1866 


5,455,387 


1847 


7,158,800 


1857 


6,089,343 


1867 


5,389,161 


1848 


7,002,164 


1858 


6,015,400 


1868 


5,323,736 


1849 


6,848,931 


1859 


5,941,947 


1869 


5,259,100 


1850 


6,699,063 


1860 


5,870,226 


1870 


5,195,236 



Prom census returns — remaining years calculated. 



Table 19. 



Showing proportion of the Insane to the total of population of Ireland for the 
years 1848, 1851, 1855, 1856, and 1861. 



YEAE. 



S3 

B 

0-* 



o 



o o 

►3 o 

£ 2 
i — i p 

2 M 

p 

CO 

s» 



CD 



o 5 
2 ^ 

P CD 



o 5 



1848. 
1851. 
1855. 
1856. 
1861. 
1870. 



11,678* 

15,098 

13,493 

14,141 

16,749 

17,194 



7,002,164 
6,552,385 
6,239,928 
6,164,171 
5,798,967 
5,195,336 



1 to 600 
1 to 414 
1 to 462 
1 to 435 
1 to 346 
1 to 302 



^Approximately. 



265 

IEELAND. 

Table 20. 

Civil condition of Patients in Asylums of Ireland on the first of December, 

eighteen hundred and seventy. 



CIYIL COXDITIOX. 



Males 



Females. 



Total. 



Single 

Married.... 
Widowed., 
Unknown 

Total... 



3.006 
701 
113 
170 



2.251 
747 
310 
162 




5.257 

1448 
423 

229 



oo. 



7.460 



Table 21. 

Showing Duration of Disease on Admission of Patients Discharged Becovered 
from the District Asylums for the Year ending December 31sf, 1870. 



Alales. 



Females. 



Total. 



Under three months 

Prom three to six months.... 
From six to twelve months. 

From one to two years 

From two to three years 

From three to four years.... 

From four to five years 

From five to six years 

From six to eight years 

Eight years and up wards.... 
JSTot specified 



Totals 



539 

35 

32 

21 

10 

7 

4 

1 

1 

11 

57 



518 



313 
46 
32 
25 

14 
4 
1 

1 
1 
5 

48 



490 



625 

81 

64 

46 

24 

11 

5 

2 

2 

16 

105 



1,008 



34 



' 



266 

IEELAKD. 

Table 22. 

Showing the number of patients in the Lunatic Asylums of Ireland, with the 
admissions, discharges, deaths and escapes, and proportion of readmissions 
to admissions for the first time. 



FOR THE YEAR ENDING DECEMBER 31, 1870. 



K 


^ H3 

CD O 


B 


CD 


H3 

o 














CD 


£S P 
P t -1 


CD 


j3 


p 
















CD 






CD 






CO 






on 





Number of patients in Asylums Dec. 31, 1869. 

Number admitted for the first time 

Number of readmissions , 

Total admissions 

Total number under treatment 

Number discharged recovered 

Number discharged relieved , 

Number discharged not improved 

Died 



Escaped 

Total discharged, died and escaped 

Number remaining December 31, 1870 

Proportion per cent of readmissions to admis- 
sions for the first time 



1,141 

224 



549 

166 

61 

378 
9 



971 
196 



539 

110 

50 

330 

1 



2,112 
420 



1,088 

276 

111 

708 

10. 



3,7! 



1,365 
5,153 



1,163 
3 990 

19.6 



3,333 



1,167 
4,500 



1,030 
3,470 

20.1 



7,121 



2,532 
9,653 



2,193 
7,460 

19.8 





Males. 


Females. 


Total. 




40. 
10.6 
27.7 
7.3 


46: 

11.9 

28.2 
7.3 


43. 


Proportion per cent of recoveries to number treated 


11.2 

27.9 


Proportion per cent of deaths to number treated 


7.3 


Proportion per cent of pauper lunatics in asylums and 


55.2 


Proportion of lunatics maintained by relatives and'others 






44.8 









267 

IRELAND. 
Table 23. 



The total number of insane (including idiots), December 31st 
1870, was.... 

These were distributed as follows: 

In di strict asylums 

In private asylums 

In Workhouses 

In Jails 

In Luc an, supported by Government ■ 

In Central Asylum for Criminal Lunatics , 

At large 



17,194 



6,655 

638 

2,754 

1 

43 

167 

6,936 



17,194 



Of this number about nine thousand four hundred and ninety-eight 
are paupers, supported in asylums or Workhouses; and the remaining 
seven thousand six hundred and ninety-six are supjDorted by relatives or 
others in asylums or elsewhere. 

The asylums are: 



District asylums 

Private licensed asylums 

Asylum for criminal lunatics 

Total 



23 

20 

1 



44 



Table 24. 

Numbers of Insane (exclusive of Idiots), December 31st, 1870. 



Males. 



Females. 



Total. 



In police districts, exclusive of those in asy- 
lums, Jails or Workhouses 

In Union Workhouses 

In district asylums 

In Jails 

In private licensed asylums 

In Central Asylum for Criminal Lunatics.... 



Totals. 



1,526 

448 
3,440 



281 
117 



5,812 



1,228 

697 

3,007 

1 

327 

50 



5,310 



2,754 

1,145 

6,447 

1 

608 

167 



11,122 



268 






p 
< 



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co 

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-*o CO 

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co co 

co '^ 



^ 



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•to ^ 

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co 









Proportion per cent 
of deaths to num- 
ber treated 



Proportion per cent 
of deaths to admis- 



sions 



Proportion per cent 
of recoveries to 
number treated 



Proportion per cent 
of recoveries to ad- 



missions 



Deaths 



Eecoveries 



Number Treated. 



Admissions 



O' 



Total. 



Female. 



Male. 



m 
o 



CO 1> 00 CO 

t-5 t> o t> 



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CO © id 

t- CO CO 

CO Tf 



lfl H ION 
CO CO O CO 



o 
© 

CO 



> 

<1 



02 
CD 

bl) 

d 
PQ 



<C3 

02 
-CD 

d 

CD 

• l—l 

o 

■n 

o 
o 



pi 

'03 

d 
o3 

DQ 

02 

<j 



H3 
d 

c3 

o 

'03 
Ph 

o 

r-< 



03 >tJ 

PI 



+3 

w. 



c5 
i— i 

o 

CD 

o 



<CD 

Pi 

O 

rd 





-d 
Pi 

CO 



c3 

3 

CD 



m cd 

Pi CD 

^ r ^ PJ 

CQ cd 

© CD H3 CD S 

•d +=: i^ <» 

03 cD °2 

d ►> CD Cj m 

,2 P, ^.^S -g 



d 

p— I .r— I •!— I ^-, 
DQ CO OQ.h 

O O O o3 



o3 
-(J 
O 



269 

BELGIUM. 
Table 2. 

Charges in Belgium Asylums Visited. 





First Class. 


Second Class. 


Third Class. 


Fourth Class 


ASYLUMS. 


Francs 
Per "Week. 


Francs 
Per Week. 


Francs 
Per Week. 


Francs 
Per Week. 


L/iege, St. Ans 


38 to 76 
7 to 11 


23 to 28 

6 


2 to 15 
5} 




Colony at Gheel 


5.00 centi. 


Asylum at Antwerp 


6.86 centi. 


Guislain Asylum, Ghent.. 


11 

19 to 57 
19 to 57 

7 


1 


5.60 centi. 


Female Asylum, Ghent... 
Du Strop Asylum, Ghent. 
St. Julian Asy., Bruges... 




7 


5.88 centi. 








2.00 centi. 







Table 3. 

Showing the Number of Patients in Lunatic Hospitals, the Admissions, Dis- 
charges and Deaths, and the Per Cent of Recoveries and of Deatlis to 
Admissions, and to Number Treated for the Year 1865. 



p 


CD 


o 


p 


o 

CO 


B 
P 

o 


p 

-f- 


o 

CO 



p 

►— < 

CD 



o 



Number of patients January 1st, 1865. 

Admissions for the first time 

Eeadmissions 

Total admissions 

Total number treated during the year. 

Discharged recovered 

Relieved 

Not improved 

Died 

Total discharges and deaths 

Remaining January 1st, 1866 



325 
126 
239 
341 



317 

99 

160 

254 



642 
225 
399 

595 



2,663 

865 

174 

1,039 

3,702 



1,031 
2,671 



2,778 
690 
122 
812 

3,590 



830 
2,760 



5,441 
1,555 
296 
1,851 
7,292 



1,861 
5,431 



270 



BELGIUM. 

Table 3 — Continued. 



K 

p 


cd 


CD 


3 




p 




i — i 




CD 


31.2 


39.0 


8.7 


8.8 


32.8 


31.2 


9.2 


7.0 



►3 
o 



Proportion per cent of recoveries to admissions 

Proportion per cent of recoveries to number treated 

Proportion per cent of deaths to admissions ... 

Proportion per cent of deaths to number treated 



34.6 

8.8 

32.1 

8.1 



Table 4. 

Belgium, 1863, 1864, and 1865 — Fifty-one Asylums. 









H 




i-3 


H 


ri 


H 


H 


H 


»-3 




Number Eesident. 


o 

e-t- 

JO 


p 


IS- 


» 


P go 


P JO 


w p 


«*-2. 
o g* 








3 


a> 


si ' 


11 y 

B 


n 


p> 

P'CD 


P. CD 


5 © 


^^T 










p © 


YEAE. 


CD 
to 


CD 

B 

P 

CD 


o 

P 


o. Adn 


2^ 
O 

CD 


cr* 

CD 


o 

CD 

P. 




3 ^ 

TO CD 


TO CD 
00 p 

P o 


CD CD 

4 s 


CTCD 
2 P 








to 








P 


Q 


O 




M 2. 


TO ^ 


H 2. 


i-* >-is 














c-t- 

CD 


e-t- 

CD 


H 


hi 

o 




: ^ 
: Q 


: cd 


CD *-*» 
















J"~ ' 


: 


P. 


►J 

CD 




: cd 


: p 

. <r+- 

: P* 


: ct> 


CD p 

i P? 












• 




1 




• aa 


• TO 


• TO 


' TO 


1863 


2,587 


2,583 


5,170 


1,694 


6,864 


% 605 


373 l 


320 


35.50 


30.51 


8.81 


7.57 


1864 


2,673 


2,693 


5,366 


1,669 


7,035 


577 


427 


390 


34.57 


35.35 


8.20 


8.38 


1865 


2,663 


2,778 


5,441 


1,851 


7,292 


642 


624 


595 


34.68 


32.14 


8.80 


8.15 


Total- 


7,923 


8,054 


15,977 


5,214 


21,191 


1,824 1 


,424 1,' 


ros 


34.98 


32.70 


8.60 


8.04 



271 

BELGIUM. 

Table 5. 

Increase of Insane Persons in Belgian Asylums for Ten Years (1856 to 1865), 

and Annual Increase. 



TEAES. 



Number of 
Insane. 



Increase. 



In 1856. 
In 1857. 
In 1858. 
In 1859. 
In 1860. 
In 1861. 
In 1862. 
In 1863. 
In 1864. 
In 1865. 



Total for ten years 
Annual increase 



4,278 
4,431 
4,508 
4,677 
4,882 
5,033 
5,170 
5,366 
5,441 
5,431 



49.217 



153 

77 
169 
205 
151 
137 
196 

75 
10 less 



115 



Number of asylums in Belgium 

For the reception of men 

For the reception of women 

For the reception of men and women. 

For pay and non-paying 

For j)ay patients only 

For paupers only 

Number of patients in all 



51 

17 
17 
17 
27 
16 
8 
5,431 



The superior medical officers of the asylums in Belgium are paid in 
proportion to the number of patients under their care, as follows: 



NUMBER OF PATIEXTS. 



Francs. 



In an asylum of 50 patients 

In an asylum of 100 patients 

T t PiKA *• 4. f Head Physician , 

In an asylum of lo0 patients j ABBiBtan £ 

In an asylum of 200 to 250 patients -! » e . , ^ 

In an asylum of 250 to 300 patients < » . , ? 



1,460 
2,500 
2,500 

700 
2,800 

850 
3,500 
1,200 



272 



O 
W 



^ 




o 




^3 


^ 


SS 


to 


53 


CO 


CO 


fo 


co 


^> 




co 


^ 




CO 

o 

co 


53 


CO 


"53 




s\) 


CO 


Ss, 


r< 


^S 


to 


se 


^ 


53 


CV 


r-o: 


to 


CO 


CO 


CO 


CO 


to 


CO 


l"<sf 


?M 


co 


_& 








o 


•o» 


*03 

to 

Ss. 


"53 

CO 


o 


to 






©" 


CO 


5-, 


rO 


a. 


^ 


co 


fi 


to 


53 






53 


S 


co" 


•&• 


f< 




to 


CO 


53 


to 


CD co 


^-o 


H r^ 


^ 




co 


02 ^ 


^ 


H g 


CO 




to 


?*» 




CO 


S°, 


£> 


*cO 


o 

CJ> 


"53 


<o 


CO 




to 


^^ 


53 


CO 

<o 


CO 
to 


© 








CO 


co 


CO 


kCi 




<o 










^3 


5s 


53 





CO 



CO 
to 



to 


to 


?) 


"53 


^3 




co 




^j 


CO 


5s 


r»a 






CO 


O 


to 




CO 


co 

CO 


•co 




53 


S: 

"53 

53 


^ 


CO 


<o 


r< 




to 






"■O 


<^ 


•iO 


to 


<o 




tsT 


CO 


*s> 


f< 




to 


<s» 


53 


5S^ 


CO 


a 


si 






53 




© 




kc 




Q 





O "J 




OJMO 


°1 




*> P 


Number 


Gooid 


ci 


r-« CO 

a p 




r— 1 




p 53 








r-t O 








§■# 








o 








• r-l CO 








££ 




O00H 


i-H 


Pj 


Admissions.... 


ifliOCO 


o 


g^S 




CO LQ Ttl 


■^ 


Ph 








S-3 








CD 


Number 


CO CO i> 


CO 


o o 

^ co 


ocoj> 

i-l 


t^ 


9. cS 








P>S 








H 








.2 © 














•+J o 








rH CD 




co ©q co 


CO 


O H 
PsM 


Admissions.... 


o od co 


CO 


p o 




rtl CO CO 


co 


Ph 










fc- CO <M 

■^ t- oq 


1 

T— 1 






tH cq i> 

lOlOH 


1 

CO 
i—l 






CO CO o 


CO 


Numb 




(N C<1 <M 

iO GO <M 


CD 










T-T 




TffCOH 

co co i^: 
■t— i i—i 


CO 








Ci t— c: 


xO 


co 


Total 


co co co 

CO sO i— 






CD 








-I- 3 






l—i 


ci 








ft+3 








Pi 




i—l CO o 


^H 


o[© 




OS L— O 

1— 1 CO T-1 


CD 
CD 


H CD 








CO H 


« 












H, 








rn 




co -^H o: 


i—l 


S 


Males 


C51H CC 
i—l CO 


CO 




» 












P 












1-1 












H 


• 










CO 












-4 












O 










H 


?H 








<1 


<^ 








£ 


pi ciJO 








* fc E 

K. © — 






!h . cj ^ 


o 




.2 Z 


^ 




■S 1* 


1 




<D _<!> C 


) 






PC 


JS 


p: 







s 



w 
O 

q=l 

CM 
CN 



t3 



CD 

Cm 

CD 
O 



o 

epl 
<M 

«3 



O 

CP5 

O 

o 



^ 


s« 


o 


CD 
O 






H 


cS 


w 


w 


O 


•+J 


u 


CD 




CO 
















rH 




o 




«rt 






O 

cp| 

o 
o 
1^ 



CD 

CD 
. > 

co C3 

"=Pl c3 

co CD 
§>> 

^^ 

ct3 CD 

crt P. 

.3c3 

MCE) 
CC CD 

<=> s 

o o 
co ^ 

co~^ 
co P< 

H ^ 
^ 02 

<2 "3 

o 

•PI P 

O M 

qp CP 

^•^ 
O -^ 

o o 
^ <x> 

co > 

co i — i 
ci co 

-£ 

£ CD 
1*2 C3 



o • 

co o 

CD C5 

CD Ph 



O O 

qp P 
^ O 



rt 



Ph 



'* 



CD -P 
P co CD 

"ta'cDrS 

S+* « 

•r-l cO-rn 
CD.fc! H 

rO C> I 

; « 12 g 

! CD Is «.2 

■ rl l»K+ ) 



HOLLAND. 

Table 7. 

Showing number of Patients in Lunatic Hospitals, with Admissions, Discharges, 
Recoveries, and Deaths for the Year. 







o 

B 

Cd" 


Total 




a> 

B 

CD 


o 










1,521 

500 

2,021 


1,658 

494 

2,152 


3,179 
994 










Treated during the vear 








4,173 


Discharged during the year recovered 


177 
36 
35 

193 


203 
33 
36 

165 


380 
69 
71 

358 


Relieved 
















Died 










441 

1,580 


437 
1,715 


878 


Number remaining January 1st, 1869 








3,295 













• 


ST 1 


CD 

3 

p 

CD 1 


Total 




35.4 

8.7 

38.6 

9.5 


41.0 
9.4 

33.8 
7.6 


38.2 




9.1 




36.0 




8.5 







Number of insane in asylums January 1st, 1868. 

Population of Holland in 1868 

Proportion of insane to population 



3,179 

3,592,415 

1 in 1.130 



Principal causes of death: marasmus, consumption, apoplexy, and 
general paralysis. 



35 



274 

HOLLAND. 
Table 8 . 





ADMITTED. 


AGE. 


From 1844 to 1854. 


From 1854 to 1864. 


Totals. 




cd 
w 


cd 

B 

P 

a> 


o 

P 


SO 

CD 
VI 


CD 

B 
P 

cd' 

CO 


o 

e-r- 

P 
GO 


CD 
CD 


CD 

P 
>— ' 
CD 
Go 


H3 

o 

Ct- 

P 

CO 


Less than ten years 

Ten to twenty years 


13 

142 
551 
672 
564 
303 
135 
47 


7 

94 
490 
569 
462 
382 
198 
101 

2,303 


20 

236 

1,041 

1,241 

1,026 

685 

333 

148 


27 

255 
788 
888 
692 
490 
242 
79 


19 
162 
852 
916 
652 
497 


46 40 

417 397 

1.640 1,339 

1,804 1,560 

1,344 l-25fi 


26 

256 

1,342 

1,485 

1,114 

879 

490 

241 


66 
653 


Twenty to thirty years 

Thirty to forty years 


2,681 
3,045 
2,370 
1,672 
867 
367 


Forty to fifty years 




987 


793 
377 
126 


Ov^er seventy years 


292 | 534 
140 1 219 






Totals 


2,427 


4,730 
^ 


3,461 


3,530 6,991 


5,8S8 


5,833 , 11,721 



Married 

Unmarried 

Totals ., 



1,040 
1,387 


927 
1,376 


1,967 
2,763 


1,334 
2,127 


1,274 

2,256 


2,608 
4,383 

6,991 


2,374 
3,514 


2,201 
3,632 


2,427 


2,303 


4,730 


3,461 


3,530 


5,888 


o,833 



4,575 
7,146 

11,721 



Relapsed cases 


1,985 
442 


1,790 3,775 
513 955 


2,762 
699 


2,736 
794 


5,498 
1,493 


4,747 
1,141 

5,888 


4,526 
1,307 


9,273 

2,448 




Totals 


2,427 


2,303 4,730 


3,461 


3,530 


6,991 


5,833 


11,721 







Hereditary 

Not hereditary. 

Totals 



366 
2,061 


457 

1,846 


823 
3,907 

4,730 


1 
879 1,039 
2,582 2,491 


1,918 
5,073 


1.345 
4,643 

5,888 


T.496 
4,337 


2,427 


2,303 


3,461 ; 3,530 


6,991 


5,833 



2,741 
8,980 

11,721 



From intemperance 


307 

2,120 


53 
2,250 


360 
4,370 

4,730 


586 
2,875 


109 
3,421 


695 
6,296 


893 


162 


1,055 
4,066 




4,995 5,871 


Totals 


2,427 


2,303 


3,461 


3,530 


6,991 


5,888 


5,833 


11,721 







Mania 

Monomania- 
Melancholia. 

Dementia 

Idiotisme 

Epilepsia .... 

Totals ... 



871 


981 


1,852 


1,554 


1,574 


3,128 


2,425 


2,555 


436 


331 


767 


212 


221 


433 


648 


552 


322 


434 


756 


635 


883 


1,518 


957 


1,317 


507 


391 


898 


622 


554 


1,176 


1,129 


945 


98 


70 


168 


162 


99 


261 


260 


169 


193 


96 


289 


276 


199 


475 


469 


295 


2,427 


2,303 


4,730 


3,461 


3,530 


6,991 


5,888 


5,833 



4,980 
1,200 
2,274 
2,074 
429 
764 

11,721 



275 

HOLLAND. 

Table 8 — (Continued.) 



AGE. 



CUBED. 



From 1844 to 1854. From 1854 to 1864. 



Totals. 



© 

B 
p 



i-3 
c 


p 


© 


CD 


© 


3 

©* 

CD 


2 


1 


1 


83 


87 


59 


415 


313 


•419 


466 


312 


437 


358 


246 


267 


249 


184 


164 


94 


80 


76 


28 


14 


18 


1,605 


1,237 


1,441 



o 



3 
p 



H3 

o 



Less than ten years 

Ten to twenty years 

Twenty to thirty years . 
Thirty to forty 3 7 ears .... 

Forty to fifty years 

Fifty to sixty years 

Sixty to seventy years... 
Over seventy years 

Totals 

Married , 

Unmarried 

Totals 

Insane for the first time 
Relapsed cases 

Totals 

Hereditary 

Not Hereditary 

Totals 

From Intemperance 

Not from intemperance. 

Totals 

Mania , 

Monomania 

Melancholia , 

Dementia 

Idiotisme 

Epilepsia 

Totals 



1 
44 

188 
222 
182 
110 
45 
6 



798 



1 

39 

227 

244 

176 

139 

49 

22 



2 
146 
732 
749 
513 
348 
156 
32 



2 
131 
501 
534 
428 
294 
125 
20 



2 

98 
646 
681 
443 
303 
125 
40 



897 



2,678 2,035 j 2,338 



4 

229 

1,147 

1,215 

871 

597 

250 

60 



4,373 



393 

405 


407 
490 


800 
895 


533 j 
704 


798 


897 


1,695 


1,237 



614 

827 



1,147 926 ! 1,021 
1,531 I 1,109 | 1,317 



1,441 



2,678 



2,035 2,338 



1,947 
2,426 



4,373 



611 

187 


640 
257 


1.251 
444 


905 
332 


997 
444 


1,902 
776 


1,516 
519 


1,637 
701 


798 


897 


1,695 


1,237 


1,441 


2,678 


2,035 


2,338 



124 
674 


164 
733 


288 
1,407 


338 
899 


437 

1,004 


775 
1,903 


462 
1,573 


601 
1,737 


798 


897 


1,695 


1,237 j 1,441 


2,678 


2,035 

• 


2,338 



135 
663 

798 


21 
876 


156 

1,539 

1,695 


231 
1,006 


50 
1,391 


281 
2,397 


366 
1,669 


71 

2,267 


897 


1,237 


1,441 


2,678 


2,035 


2,338 



425 


515 


940 


782 


818 


1,600 


1,207 


1,333 


154 


135 


289 


84 


79 


163 


238 


214 


132 


198 


330 


260 


442 


702 


392 


640 


61 


41 


102 


83 


90 


173 


144 


131 


4 


2 


6 


7 


2 


9 


11 


4 


22 


6 


28 


21 


10 


31 


43 


16 


798 


897 


1,695 


1,237 


1,441 


2,678 


2,035 


2,338 



3,153 
1,220 

4,373 



1,063 
3,310 

4,373 



437 
3,936 



2,540 

452 

1,032 

275 

15 

59 

4,373 



276 

HOLLAND. 
Table 8 — (Continued.) 



AGE. 



Less than ten years 

Ten to twenty years .... 
Twenty to thirty years . 

Thirty to forty years 

Forty to fifty years 

Fifty to sixty years 

Sixty to seventy years... 
Over seventy years 

Totals 

Married 

Unmarried 

Totals 

Insane for the first time. 
Eelapsed cases 

Totals 

Hereditary 

Not hereditary 

Totals 

From intemperance 

Not from intemperance. 

Totals 



DIED. 



From 1844 to 1854. 



From 1854 to 1864. 



Totals. 



CD 


CO 

B 




SB 








CD 




t» 


2 




28 


7 


107 


70 


216 


120 


258 


133 


170 


150 


88 


111 


48 


102 


917 


693 



i-3 
o 



CD 

B 

go 



2 


7 


35 


35 


177 


183 


336 


308 


391 


317 


320 


261 


199 


146 


150 


81 


1,610 


1,338 



4 
34 
107 
211 
204 
204 
213 
173 



1,150 



c 



*4 

CD 

3 



11 


9 


4 


69 


63 


41 


290 


290 


177 


519 


524 


331 


521 


575 


337 


465 


431 


354 


359 


234 


324 


254 


129 


375 


2,488 


2,255 


1,843 



i-3 
o 



13 

104 

467 
855 
912 

785 
558 
404 



437 

480 


265 

428 


702 

908 


557 

781 


378 

772 


935 
1,553 


994 
1,261 


643 

1,200 


917 


693 


1,610 


1,338 


1,150 


2,488 


2,255 


1,843 



815 

102 


618 
75 


1,433 
177 


1,186 
152 


1,006 
144 


2,192 
296 


2,001 
254 


1,624 
219 


917 


693 


1,610 


1,338 


1,150 


2,488 


2,255 


1,843 



100 

817 


87 
606 


187 
1,423 


230 
1,108 


252 
998 


482 
2,006 


330 
1,925 


339 
1,504 

1,843 


917 


693 


1,610 


1,338 


1,150 


2,488 


2,255 



91 

286 


15 

678 


106 
1,504 


190 

1,148 


31 
1,119 


221 

2,267 


281 
1,974 


46 
1,797 


917 


693 


1,610 


1,338 


1,150 


2,488 


2,255 


1,843 



1,637 
2,461 

4,098 



3,625 
473 

4,098 



669 
3,429 

4,098 



327 
3,771 

4,098 





247 

124 

70 

358 
40 

78 


186 
88 
89 

245 
29 
56 


433 
212 
159 
603 
69 
134 


400 
77 

182 

414 
63 

202 


348 
77 

200 

368 
42 

115 


748 
154 
382 
782 
105 
317 


647 
201 
252 
772 
103 
280 


536 
165 
289 
613 
71 
171 


1,181 


Monomania 


366 


Melancholia 


541 


Idiotisme 


1,385 
174 




451 






Totals 


917 


693 


1,610 


1,338 


1,150 


2,488 


2,255 


1,843 


4,098 





277 





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Females 



Males. 



Totals. 



Females 



Males. 



Totals.... 



Females 



Males. 



o 



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Females 



Males. 



Totals- 



Females 



Males. 



Totals- 



Females 



Males. 



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278 

HOLLAND. 
Table 9. 





Admitted. 


Cured. 


Died. 




1844 

to 

1854 


1854 

to 

1864 




1844 

to 

1854 


1854 

to 

1864 




1844 

to 

1854 


1854 

to 

1864 






41.6 

58.4 


37.3 

62.7 


39.4 
60.6 


47.2 
52.8 


42.8 
57.2 


45 
55 


42.9 
57.1 


37.3 
62.7 


40.1 




59.9 






Insane for the first time 


100 

79.8 
20.2 


100 

78.6 
21.4 


100 

79.2 

20.8 


100 

73.9 
26.1 


100 

71.2 

28.8 


100 

72.6 

27.4 


100 

89 
11 


100 

88.1 
11.9 


100 

88.6 
11.4 








100 

17.4 

82.6 


100 

27.4 
72.6 


100 

22.4 
77.6 


100 

17 

83 


100 

28.9 
71.1 


100 

22.9 
77.1 


100 

11.6 

88.4 


100 

19.4 

80.6 


100 
15.6 




84.4 








100 

7.6 
92.4 


100 

9.9 

90.1 


100 

8.8 
91.2 


100 

9.2 

90.8 


100 

10.5 
89.5 


100 

10.3 

89.7 


100 

6.6 

93.4 


100 

8.9 
91.1 


100 
7.3 




92.7 




100 

39.2 

16.2 

16 

19 
3.5 
6.1 

100 


100 

44.8 

6.2 

21.7 

16.8 

3.7 

6.8 


100 

42 
11.2 

18.8 

18 
3.6 
6.4 


100 

55.3 

17.2 

19.3 

6.1 

0.4 

1.7 


100 

60 
6.1 

25.8 
6.5 
0.4 
1.2 


100 

57.7 

11.7 

22.5 

6.3 

0.4 

1.4 


100 

26.9 
13.1 
10.2 
37.2 
4.3 
8.3 


100 

30.1 
6.2 

15.5 

31.5 
4.1 

12.6 


100 
28.5 




9.7 




12.9 




34.3 




4.2 




10.4 








100 


100 


100 


100 


100 


100 


100 


100 



279 






CO 

co 
co 
s*» 
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to 

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co 

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Treated. 



Admisions. 



« 'B 
.2 o 

o o 

ft 

o 

Sh 



Treated. 



Admissions. 



Died. 



Cured. 



Treated 



Admitted. 



03 . 



°r2 

Q3 f-i 
£ 



Total. 



Females. 



Males 



cidoo 



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■^ "^ "^ 



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co 
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03 

t-3 

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oi 
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92 

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280 



Hi 






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co 

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Per cent of deaths 
to number treated 


• cq <-" oo co io : ©" cq* cq* ©" co" tj" co * 
: th th : ih ih ih : 


© 

rH 


Per cent of cures to 
number treated ... 


• i> co co* co io* • cq° © io* cq hh" ©* io : 

. CJ rH (M rH . rH rH rH i— 1 (M rH | 


CO* ■ 
rH 


Per cent of deaths 


• CO* © C* l>* CO *0* OS OS GO l> CO GO rH : 

. NWlMmHCOCONiTOH CM . 


rH 
CO 


Per cent of cures on 


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: ©cq ic 

• CO GO 1> 

: coi- 


o o" id co' o h5 th oi o* t-" • 

l^COCq^COCOrHCOH^-'*! . 


00* 

CO 


ISTumber 
Died. 


Total 


COCN[lOCO©C5C0 1>>COCO • 

cs co tji cd co co oq : 
I— t 


rH 

cq 

CO 


Female- 


: : : ih : : : 

: : : ^ : : : 


o cq cq co 

CO >0 rH 








: : :co : : :co : r>- <h -*t co : : 
:::co:::co:rorH ; ; 




o . 

CD'S 

> £ 

o "- 1 

£ o 
1— 1 


Total . . 


: co co 

: rH rH 


' CO O lOGO 
: (M I"- rH CO 


00 rH © © ' 

rH rH rH I 


© 
cq 
cq 


Female... 


:i> : 




00 

CO 


■<h co io : : 


Male 


: ^ : 


: : : io 
: : : rH 




ihgoio j ' 




ft 

CD -4 


Total 


: © O GO O CO CO "**• O CO Oi J> HH GO ■ 
; r- 1 i— 1 t— 1 


© 


Female... 


: c: : o : : : 
: : "^> : : : 


o co io co o : : 
io co : ; 




Male..., 


:© too : : : ■* ico^ihos : : 
: cq : o> : ; : t- : ■* rt ; : 




ft ; 


Total 


:n(Noonio '.i^coc&rHTticcio : 
: o n oo io io "Oicoocoi— icoi— i • 

I ; r-i t* CO CN GO : IO •* CO 00 rH i-H : 


© 

rH 
CO 

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Female... 


• U0 • uO • •' • 

: co : <m : : : 
: :■*.::: 


CO rH rH CO 
GO O GO CO 
Tt* Ttl rH 






Male 


' CN ' CO : : : 1- 

: i- : co : : : cs 

: : "^ : : : ^5 


00 ©00 
Ci CO t> 






CD a> 

a- 


Total 


t CO tO CO lO lO CO O CO O rH CO »o CO " 
: Ttl CM CO GO "* C5 CD IO CN CD ■* CO CO : 
j rH CM CO CM rH rH CO 


co 
os 


Female... 


; CO : (N : : I> 

: rH : rH : : CO 
: : ■— • : : »- 1 


OJHHCqN • • 
IO OS CO rH rH '. '. 
rH rH • • 




Male. ,.. 


• O • rH • ' Ci O 

: co : io : : o co 
: : rH ; ; rH rH 


© © rH CO • 

cq co co rH : : 

rH • ; 




,0 CD 

rt CO 


Total 


O H MO (N O INOOOHCONH 
COCOHHCMl'^rH :cOCOCO©t-COl-~l> 
lO COCCrHiO : -^ CO CO CO 


__!__ 


Female... 


lO 0^ 1> CO •' •' ' 

■*(Mhh : : : 
cn cn co ; ; : 


c 


© © ^H 
rH IO CNI 
CM rH 


•'© 
: ^ 


Male 


lO (M O <N : ' : t- 

go •* co rH : : : cc 
cm ■* co : : : "* 




© © 1> 
rH rH 


: 1 : 
• "*i i 
: »o : 




% 

P 

Hi 

H 

«! 
PR 

o 

m 


T^rnnfi 


: : : c 
: : : « 

C3§|^ 

h ors i" 

CPr-5 O K 


a 

"B 
a 

t> 

5 

P- 

CC 

1 

P 

% 

-J 


I 
« 

E 

1 

Eg 


c 
E 

c 


r- 
P 


c 

1 

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'■ S 
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: o 
• -*-> 

: a 

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o .3 
Phco 


O 

EH 






281 



ITALY. 
Table 12. 

General Movement of Population of Lunatic Asylums — 1867. 



Number of patients in asylums January 1st, 1867 ... 

Number of patients admitted during the year 

Number of patients discharged during the year 

Number of patients died during the year 

Number of patients remaining December 31st, 1867 

Proportion per cent of discharges on admissions*.... 

Proportion per cent of deaths on admissions 

Proportion per cent of deaths on number treated.... 



8,191 
4,909 
3,210 
1,504 

8,386 

65 
30 
11 



* The discharges are all given together, hence it is impossible to say what proportion 
recovered. 



Table 13, 

Showing the Hereditary Tendency to Insanity among Patients Admitted and 
Cured during the Year 1868, and among those remaining January 1st, 
1869, in the Lunatic Asylum at Florence. 





Admitted. 


Cured. 


Kemaining. 


CASES. 




CD 

B 


o 


Q 1 


CD 

B 

CD 


H3 
O 
rt- 
P 
i — i 


p 

CD - * 


CD 

B 

CD 


H3 

o 

P 

1— ' 




67 
44 
62 


41 
55 

45 


108 

99 

107 


28 
18 
26 


17 
24 
16 


45 
42 
42 


80 
104 
142 

2 


102 
110 
167 


182 


Hereditary tendency not admitted.... 


214 
309 




2 










72 








Tota 1 . 


173 


141 


314 


57 


129 


328 


379 


707 







36 



282 



Hi 

M 
CQ 
Q 

W 
Eh 



PQ 
EH 



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Kg Kt 


to 


to 


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So 

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^3 

to 


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£ 


« 




^ 


CO 




?g 


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S 


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cv 


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4; 


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co 




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03 


r-o 


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CO 




CO 

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CO 

P3 


bn 




!k 


CO 

sg 

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CO 
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co 

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£ 


g 


<0 


■^3 Kg 


^ 


to 



^ **° 

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J5 « 1 

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^ -2 ^ 

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<i -^ ^5 

CO "+ CO 
^ © •£ 

So ■*■» ss 

MKg^Q 

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«. ©*Kg 
3^> to 

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co S3 
£>- co r-i 

© 



Proportion per cent 
of deaths to num- 
ber treated 



Proportion per cent 
of deaths to ad- 



missions. 



Proportion per cent 
of recoveries to 
number treated... 



Proportion per cent 
of recoveries to 
admissions 



Died 



Cured 



Treated. 



Admitted. 



e*% 



o 



£ 



Total. 



Female. 



Male , 



m 

1-3 

m 



«o io «q tjj t> tij 

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t-^ cq m cq oo © 
cq w cq co cq cq 

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co cq co co 



©© 

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oq th 



© co 
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cq cq 



c5 

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£ S * 5 



c3 o3 

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cq co cq 

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ta co co cq 

t>^ i^ cq* co 

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lO© T(H © 

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cq co ■* 



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cq © © io 

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io io cq © 
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■sofa's J? 

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283 



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co co cm co a 


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cs o> co" od i— 1^ 


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cq iO rh iO CO C£ 


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Fig. i, 



Reference: 

D C— Douch Cocks. 
B S— Barrel Shower. 
H S— Head Shower. 
L S — Lumbar Shower. 
S S — Spinal Shower. 
0— Foot Pans fixed. 



Fig. 2. 



Reference: 



B— Ventilating Pipe. 

L— Floor. 

0— Rubber Gaskets. 



[Appendix G.] 





Plan of Baths at Evreux. 




!(C A 



®© @4 



Plan of Water Closet. 







Section through IK. 



37 



Plan of Water Closet, Washington. 






290 
[Appendix G.] 



Fig. 3- 




' a\\ V. 

/ f\T 

V 

1^. 


\ 
\ 

\ 



Kitchen Boiler on pivot, at Ville Evrard Asylum. 



Fig. 4. 




Gas Lamp at Evreux. 



Fig. 5- 



ITall 



Seat LsvelofGfwnl 




Ha-ha Fence and Seat at the Darby Asylum. 



291 



LIST OF ASYLUMS IN FEANCE. 



WHERE SITUATED. 



Department. 



Aisne 

Ain 

Ain 

Allier 

Ardeche 

Ariege 

Aude 

Aveyron 

Bous. du Ehone. 
Bous. du Ehone. 
Bous. du Ehone. 

Calvados 

Cantal 

Charente 

Charente Inf. 

Cher 

Correze 

CoteD'Or *.. 

Cotes du Nord... 
Cotes du Nord... 

Doubs 

Eure 

Eure et Loir 

Finistere 

Finistere 

Haute- Garonne . 
Haute-Garonne . 

Gers 

Gironde 

Gironde 

Gironde 

Herault 

Herault 

Ille et Vilaine.... 
Indre et Loire... 

Isere 

Jura 

Jura 

Loir-et-Cher 

Hte. Loire 

Loire Inferieure 
Loire Inferieure 



Commune. 



Name of Establishment. 



Laon (Premontin). 

Bourg 

Bourg 

Yzeure 

Privas 

St. Lizier 

Limoux 

Eodez 

Marseille 

Aix 

St. Eemy 

Caen 

Aurillac 

Angouleme 

La Eochelle 



Bourges 

Mouestier-Merline. 

Dijon 

St. Brieuc 

Lehon 

Besancon 

Evreux 

Chartres 

Quimper 

Morlaix 

Toulouse 

Toulouse 

Auch 

Bordeaux 

Cadillac 

Bouscat 

Montpellier 

Montpellier 

Eennes 

Tours 

Ste. Egreve 

Dole 

Dole 

Blois 

Le Puy 

Nantes 

Nantes 



St. Lazare. 

Ste. Madeleine. 

Ste. Catherine. 

Ste. Marie Assompt'n. 

St. Lizier. 

St. Joseph de Cluny. 

Eodez. 

St. Pierre. 

La Trinite. 

St. Paul. 

Bon Sauveur. 

Aurillac. 

Angouleme. 

Lafond. 

Bourges. 

La Cellette. 

La Chartreuse. 

St. Brieuc. 

Sacres Coeurs. 

Mon. M. Guibard. 

Evreux. 

Bonneval. 

St. Athanase. 

Morlaix. 

La Grave. 

Mon. Delage. 

Auch. 

Bordeaux. 

St. Leonard. 

Castel d'Andorte. 

St. Charles. 

Pont St. Come. 

St. Meen. 

Tours. 

St. Eobert. 

Les Carmes. 

Les Capucins. 

Blois. 

Montredon. 

St. Jacques. 

F Grande Providence. 



I 



292 



LIST OF ASYLUMS IN FEANCE— Continued. 



WHERE SITUATED. 



Department. 



Commune. 



Name of Establishment. 



Loire Inferieure. 

Loiret 

Lot 

Lozere 

Maine et Loire.. 
Manche 



Manche 

Manche 

Manche 

Marne 

Hte. Marne 

Mayenne 

Meurthe 

Meurthe 

Meurthe 

Meuse 

Morbihan 

Moselle 

Nievre 

Nord 

JSTord 

Nord 

Oise 

Orne 

Pas de Calais 

Puy de Dome I Clermont-Ferrand 



Nantes 

Orleans 

Leyme 

St. Alban 

Ste. Gemmes et Loire 

Pontorson 

St. L6 

Priauville 

Le Mesnil Garnier 

Chalon3 

St. Dizier 

Mayenne 

Laxon 

St. Nicolas 

Jarville 

Fains 

Vannes 

Gorze 

La Charite s. Loire... 

Lille 

Armentieres 

Marquelle 

Clermont 

Alencon 

St. Tenant 



Puy de Lome. 
Bas-Pyrenees 

Bas-Ehin 

Ehone 



Ehone 

Ehone 

Ehone 

Ehone 

Ehone 

Ehone 

Sarthe 

Savoie 

Seine 

Seine 

Seine 

Seine 

Seine Infre... 
Seine Infre.. 
Deux-Sevres 



Eiom 

Pau 

Brumath 

Lyon 

Lyon 

Lyon 

Lyon 

Lyon 

Calvere 

Yaugner ay • 

Le Mans 

Chambery 

St. Maurice 

Gentilly 

Paris 

Paris et environs 

Eouen 

Sotteville les Eouen.. 
ISTiort 



Mon. Gouin. 

Orleans. 

Leyme. 

St. Alban. 

Ste. Gemmes. 

Pontorson. 

Bon Sauveur. 

Bon Sauveur. 

Ancien Convent. 

Chalons. 

St. Dizier. 

La Eoche Gandon. 

Mareville. 

St. Francois. 

La Malgrange. 

Fains. 

L'Humanite. 

Depot Mendicite. 

La Charite s. Loire. 

Lille. 

Armentieres. 

Lommelet. 

Mon. Labitte. 

Alencon. 

St. Venant. 

Ste. Marie Assompt'n. 

Eiom. 

Pau. 

Stephansfeld. 

L'Antiquaille. 

St. Jean de Dieu. 

St. Yincent Paul. 

Croix Eousse. 

Champ-Yert. 

St. Julien. 

Yaugneray. 

Le Mans. 

Bassens. 

Charenton (Imperial) 

Bicetre. 

La Salpetriere. 

Les 13 Asiles prives. 

St. Yon. 

Quatre Mares. 

La Providence. 



LIST OF ASYLUMS IN FRANCE— Continued. 



WHERE SITUATED. 


Name of Establishment. 


Department. 


Commune. 


Tarn 


Alby 


Bon Sauveur. 


Tarn et Garonne 


Montauban 


St. Jacques. 
Mont de Vers'ues. 


Vaucluse 


Avignon 


Vendee 


Napoleon Vendee 

Poitiers 


Napoleon Yendee. 
Poitiers. 


"Vienne 


lite. Vienne 


Limoges 


Limoges. 
Auxerre. 


Xonne 


Auxerre 









Fi 



[Appendix H.] 

THE TWELFTH ANNUAL COMMEMORATION 

i 

OF THE 

OPENING OF THE SUSSEX LUNATIC ASYLUM 

WILL BE HELD 

On Tuesday, 2Mh July, 1871. 

Hours — 12 noon — Morning Prayer, with Commemoration Sermon. 
Preacher, Rev. A. P. Perfect, M. A., Rector of St. John's, Lewes. 

1-2 p. m. — Dinner in the Wards (Roast Beef and Plum Pudding). 

1:30 p. M. — Luncheon for the Visitors in the Recreation Hall. 

2-3:30 p. m. — Games on the Grounds. Athletic Sports. The Ock- 
enden Band will play. 

3:30 p, m. — Mr. Basil Young will give a Musical and Comic Entertain- 
ment. 

6 p. m. — Tea. 

7 P. m. — Patient's Ball. To conclude at 9 p. m. 

THE BALL FOR THE HOUSEHOLD 

WILL TAKE PLACE 

On Thursday, July 27th. 9 p. M.-3 a. m. 
Mr. Squire's Brighton Quadrille Band will play. 
Haywood's Heath, July, 1871. 



THE ASYLUM, BOOTHAM, YORK. 

programme of entertainments, winter session, 1870-1. 

Thursday, October 13th, 1870— Ball. 
Saturday, October 15th — Meeting of Singing Class. 
Thursday, October 20th — Reading. 

Saturday, October 22d — Discussion Club Conversazione and Meeting 
of Singing Class. 






295 

Thursday, October 27th — Yocal and Instrumental Concert. 

Saturday, October 29th — Meeting of Singing Class. 

Thursday, November 3d — Ball. 

Saturday, November 5th — Meetings of Discussion Club and Singing 
Class. 

Thursday, November 10th— Lecture, " Hull Worthies," by T. T. Lam- 
bert, Esq. 

Saturday, November 12th — Meeting of Singing Class. 

Thursday, November 17th — Eeading and Musical Entertainment. 

Saturday, November 19th — Meetings of Discussion Club and Singing 
Class. 

Thursday, November 24th — Yocal and Instrumental Concert. 

Saturday, November 26th— Meeting of Singing Class. 

Thursday, December 1st — Ball. 

Saturday, December 3d — Meetings of Discussion Club and Singing 
Class. 

Thursday, December 8th — Magic Lantern Exhibition. 

Saturday, December 10th — Meeting of Singing Class. 

Thursday, December 15th — Lecture, "A Visit to a Coal Mine," by Dr. 
Procter, F.C.S. 

Saturday, December 17th — Meetings of Discussion Club and Singing 
Class. 

Thursday, December 22d — Eeading and Musical Entertainment. 

Friday, December 23d — Meeting of Singing Class. 

Thursday, December 29th — Lecture, " The History of Music, with 
Illustrations," by the Eev. H. Y. Palmer. 

Friday, December 30th — Meeting of Singing Class. 

Thursday, January 5th, 1871 — New Year's Ball. 

Friday, January 6th — Second ditto. 

Saturday, January 7th — Meeting of Singing Class. 

Thursday, January 12th — Lecture, " Thomas Gent, an Old York 
Printer," by the Eeverend Canon Eaine, M.A., Secretary to the Surtees 
Society. 

Saturday, January 14th — Discussion Club Conversazione and Meeting 
of Singing Class. 

Thursday, January 19th — Magic Lantern Exhibition. 

Saturday, January 21st — Meeting of Singing Class. 

Thursday, January 26th — Yocal and Instrumental Concert. 

Saturday, January 28th — Meetings of Discussion Club and Singing 
Class. 

Thursday, February 2d — Ball. 

Saturday, February 4th — Meeting of Singing Class. 

Thursday, February 9th — Lecture, " Some African Tribes," by Doctor 
Needham. 

Saturday, February 11th — Meeting of Discussion Club and Singing 
Class. 

Thursday, February 16th — Lecture, " Caverns and their Contents," 
by S. W. North, Esq., F.G.S. 

Saturday, February 18th — Meeting of Singing Class. 

Thursday, February 23d — Yocal and* Instrumental Concert. 

Saturday, February 25th — Meetings of Discussion Club and Singing 
Class. 

Thursday, March 2d — Ball. 

Saturday, March 4th — Meeting of Singing Class. 
Thursday, March 9th — Magic Lantern Exhibition. 



t 



296 

Saturday, March 11th — Meetings of Discussion Club and Singing Class. . 

Thursday, March 16th — Eeading and Musical Entertainment. 

Saturday, March 18th — Meeting of Singing Class. 

Thursday, March 23d — Lecture, " The Northwest Highlands and West- 
ern Islands of Scotland," by the Rev. Canon Hey, M.A. 

Saturday, March 25th — Meetings of Discussion Club and Singing 
Class. 

Thursday, March 20th — Yocal and Instrumental Concert. 

Saturday, April 1st — Meeting of Singing Class. 

Thursday, April 6th— Ball. 

Saturday, April 8th — Meetings of Discussion Club and Singing Class. 

Thursday, April 13th — Eeading. 

Saturday, April 15th — Meeting of Singing Class. 

Thursday, April 20th — Lecture, "An Analysis of the Franco-Prussian 
War," by W. Wallen, Esq. 

Saturday, April 22d — Discussion Club Conversazione and Meeting of 
Singing Class. 

Thursday, April 27th — Reading and Musical Entertainment. 

Saturday, April 29th — Meeting of Singing Class. 

The lectures and readings commence at six o'clock p. m.; the discussion 
meetings at half-past six; the balls at seven; the concerts at half-past 
seven; and the singing meetings at a quarter past eight. 



NIGHT ATTENDANTS. 

1. The duties of night attendants shall commence at eight p. M. on 
weekdays and nine on Sundays, and cease at six a. m., during which 
period they shall be responsible for the condition of the patients. 

2. They are to obtain every night from the attendants on duty in 
each ward the names of such patients as require particular attention, 
either on account of their habits, fits, illness, or disposition to self-injury, 
and to see that sufficient changes are provided for those whose habits 
are dirty. Should they find any patients wet or dirty when they go on 
duty, they must require the day attendants in charge of such patients to 
attend to them and hand them over to the night attendants in a clean, 
dry, and proper state; and the night attendants must themselves deliver 
over to the day attendants all patients in a like proper condition. 

3. They shall visit each ward at least seven times in the course of the 
night, and oftener if necessary, commencing their rounds at eight, nine, 
ten, and twelve p. m., and at two, four, and half-past five A. m. 

4. They shall administer any medicines, extra diet, wine, etc., (which 
may have been ordered by the Superintendent), at the times appointed; 
but shall not disturb any patient whom they may find sleeping, for the 
purpose of administering either food or medicine. A dry cloth or bib 
shall always be used when any patient has to be fed. 

5. They shall visit every epileptic patient on each round of the wards, 
and see that they are so lying as not to endanger life from suffocation 
during an accession of fits. Should any patient at any time be found out 
of bed or lying on his face, or with his head off the pillow, he must be 
put to bed, placed upon his back or side, with his head on the pillow, and 
shirt neck unbuttoned. 






297 

6. They shall devote particular attention to all supposed suicidal cases, 
and remove any articles by which they might possibly injure themselves. 

7. They shall use every exertion to improve the dirty patients in their 
habits, by getting them up at the stated times, and by taking such 
measures as will tend to keep them clean. Whenever any bedding is 
found wet or dirty it shall be removed immediately, and fresh clean 
bedding substituted; or if necessary the patient shall be removed to 
another room, and the one previously occupied washed out. No patient 
shall be allowed to remain in a damp or dirty room. 

8. The general quiet of the galleries must be strictly attended to, and 
any noisy patient visited and quieted, or if necessary removed to a room 
where he will not disturb the other patients. In going round the gal- 
leries, the night attendants must avoid disturbing the patients as much 
as possible; and for this purpose shall wear list shoes, and unbolt and 
shut the doors quietly. They must also lock and secure the various 
doors and windows of water closets, etc., on windy nights, to prevent 
rattling. 

9. They shall see that the various galleries are properly ventilated, 
and shall personally attend to any fires which may require to be kept 
burning during the night. 

10. In the event of any sudden illness, accident, escape, or death 
during the night, they shall report the same to the Superintendent with 
the least possible delay. 

11. They shall call the day attendants at half past five A. m., stating 
to them any peculiarity which may have occurred to their respective 
patients during the night; and before going off duty shall fill up the 
report for the night, to be left in the Superintendent's room. 

12. On Thursdays and Saturdays they shall be at liberty from two to 
eight p. m., and on Sundays from two to nine p. M.; but on other days 
they will be expected to perform certain light duties in the afternoon. 

13. In all their intercourse with the patients, they must bear in mind 
that they are insane, and consequently not responsible for their actions. 
Should any of them make use of abusive language, or offer them violence, 
they must on no account take it as an insult, but, on the contrary, use 
every endeavor to gain an influence over them by firm yet kind and 
attentive treatment. 



g8 



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299 



MISSING LIST. 



.Ward, No._ 



187 





Articles. 


Patients. 


Attendants. 




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Laundress. 



"When signed to be given to the Head Attendant. 



BBOOKWOOD ASYLUM. 

NEAR WORKING STATION, SURREY. 

Application for Situation of. 

(To be filled up in the candidate's own writing). 

Name and age 

Married, single, or widowed 

Religious persuasion 

Post address 

Can you read and write? 

Brought up to any particular trade, or class of work? 

Any knowledge of music, vocal or instrumental? 

Present occupation 

Name and address of various employers, in regular order, particularly of 
all recent ones; length of time with each, and cause of leaving. 



300 
BKOOKWOOD ASYLUM. 

BATHS — REGULATIONS TOR THE GUIDANCE OP THE ATTENDANTS. 

1. Every patient to be bathed immediately after admission, and once 
a week afterwards, unless exempted by medical order. Should there be 
the slightest doubt as to the advisability of bathing any patient, owing 
to sickness, feebleness, or excitement, immediate reference to be made to 
one of the medical officers. 

2. The name of every patient not having the customary bath to be 
inserted in the daily report sheet. 

3. In preparing a bath the cold water is always to be turned on first. 

4. Before the patient enters the bath the temperature is to be ascer- 
tained by the thermometer, and is not to be less than eighty-eight 
degrees, nor above ninety-eight degrees. In case of the thermometer 
becoming inefficient from injury, etc., all bathing operations to be sus- 
pended until another be obtained. 

5. Not more than patients to be bathed in the same water. Any 

infringement of this rule to be entered in the daily report sheet. 

6. Under no circumstances whatever are two patients to occupy the bath 
at the same time. 

7. During the employment of the bath, the room is never to be left 
without an attendant. At all other times the door is to remain locked, 
and the floor to be kept dry. 

8. Under no pretence whatever is the patient's head to be put under 
water. 

9. In the bath the body of each patient is to be well cleansed with 
soap. After coming out of the bath especial care must be taken to dry 
those patients who are feeble and helpless, and to clothe them as rapidly 
as possible. 

10. The keys are never to remain on the bath taps, nor are they to be 
employed by patients. "When not in use they are to be locked in the 
attendants' room. 

11. Any marks, bruises, wounds, sores, local pain, evidences of disease 
of any kind, complained of by the patients, or noticed by the attendant 
during any of the bathing operations, to be immediately reported to one 
of the medical officers, and also to be entered in the daily report sheet. 

12. Any deficiency in the supply of warm water, soap, towels, etc., to 
be entered in the daily report sheet. 

13. The attendants are to bear in mind that, except under medical 
order, the baths are to be employed solely for the purposes of cleanli- 
ness. 

14. Neither the cold nor the shower bath is ever to be employed, 
except under medical order, and then only in presence of one of the 
officers. When not in use the door of the latter is to remain locked, 
and the key to be kept in the dispensary. 

15. It is the duty of the head attendant to be present at all baths 
employed under medical order, and to .take care that the duration does 
not exceed the time specified in such order. He is also to supervise the 
whole of the ordinary bathing operations, to ascertain that the rules 
are rigidly carried out, and to report to the Medical Superintendent 
every infringement that may come to his knowledge. 

T. N. BKUSHFIELD, M. D., 
June, 1867. Medical Superintendent. 



301 

[Lunatics 1. (16 & 17 Vict.) Private Patient.] 
"Order" for the Eeception op a Private Patient. 

N. B. — Under all circumstances the "Order" and "Statement" below 
to be filled up by the patient's relatives or friends. — Sched. (A) No. 1, 
Sects. 4, 8. 

I, the undersigned, hereby request you to receive , whom I last 

saw at , on the (a) day of , 18 — , a (b) as a 

patient into your hospital. 

Subjoined is a statement respecting the said . 

Signed: Name, ; occupation (if any) ; place of abode, 

; degree of relationship (if any), or other circumstances of con- 



nection with the patient. 

Dated this day of , one thousand eight hundred and . 

To the Superintendent of Bethlem Hospital, St. George's Eoad, Lam- 
beth, S. 

" Statement." 

If any particulars in this Statement be not known, the fact to be so stated. 

Name of patient, with Christian name at length, ; Sex and 

age, ; Married, single, or widowed, — j Condition of life and 

previous occupation (if any), ; Religious persuasion, as far as 

known, • Previous place of abode, j Whether first attack, 

; Age (if known) on first attack, ; When and where pre- 
viously under care and treatment, ; Duration of existing attack, 

j Supposed cause, ; Whether subject to epilepsy, ; 

Whether suicidal, ; Whether dangerous to others, ; Whether 

found lunatic by inquisition, and date of commission or order for inquisi- 
tion, ; Special circumstances (if any) preventing the patient being 

examined, before admission, separately by two medical practitioners, 

j Name and address of relative to whom notice of death is to be 

sent, . 

How many previous attacks ? ; Have any relatives of the fam- 
ily been similarly affected ? ; State in what degree of relationship, 

; Has the patient been of sober habits ? ; Number of chil- 
dren ? ; Age of youngest ? ; Degree of education ? . 



Signed: Name, (e) ; occupation (if any), j place of abode, 



Degree of relationship (if any) or other circumstances of connection 
with the patient, . 

(a) Within one month previous to the date of the order. 

(6) Lunatic or an idiot, or a person of unsound mind. 

(e) The " Statement " must- be signed, but " where the person signing the statement is 
not the person who signs the order, the following particulars concerning the person signing, 
the statement are to be added." • 



302 

[8 & 9 Vict., Cap. 100. Sec. xlv.] 



. 



N. B. — Medical certificates of patients' examination, and the signa 
tures, are required by the above statute to be dated within seven clear 
days of the patient's reception. In stating the residence, the number of 
the house must be specified when there is any. 

The medical men signing the certificates must not be in partnership, 
nor one an assistant to the other. 

By Order or the Commissioners in Lunacy. 

1. — It is absolutely necessary that the medical men should write their 
certificates legibly, so as to afford the opportunity of an exact copy be- 
ing made. 

2. — ff All alterations in the original certificates, unless by the certify- 
ing medical man, invalidate them; and the initials of the latter must be 
placed to every change or addition made." 

3. — " If a registered medical man describes himself as l a duly quali- 
fied registered practitioner,' it is not necessary that he should specify his 
medical qualifications in full in addition." 

Medical Certificate. — Sched. (A) No. 2, Sects. 4, 5, 8, 10, 11, 12, 13. 

I, the undersigned, , being (a) , and being in actual prac- 
tice as a (b) , hereby certify that I, on the day of , 

18 , at (c) [here insert the street and number of house, if any,] , 

in the County of , separately from any other medical practitioner, 

personally examined , of (d), [state address and occupation, if 

any,] and that the said is a (e) , and a proper person to be 

taken charge of and detained under care and treatment, and that I have 
formed this opinion upon the following grounds, viz: 

1. Pacts indicating insanity observed by myself (/) [some definite fact 
or facts must be specified,] ; 

2. Other facts, if any, indicating insanity communicated to me by 
others (#), [state the name of the person giving the information,] . 

Signed: Name, ; place of abode, ; dated this day 

of , one thousand eight hundred and . 

[Here follows duplicate of above certificate.] 

_ (a) Here set forth the qualification entitling the person certifying to practice as a phy- 
sician, surgeon, or apothecary, ex gra.; Fellow of the Eoyal College of Physicians in 
London. 
(&) Physician, surgeon, or apothecary, as the case may be. 

(c) Here insert the street and number of the house, if any, or other like particulars. 

(d) A. B., of ^insert residence and profession or occupation, if any. 

(e) Lunatic or an idiot, or a person of unsound mind. 
(/) Here insert the facts. Some definite fact or facts must be specified. Please to write 

the facts legibly and on the lines. 
(g) Here state the information and from whom received. 



303 



COMPLAINT AND COMMITMENT. 

State of California, County of . 

To Honorable , County Judge of said county. respect- 
fully represents that there is now in said county a person named , 

who is insane, and by reason of insanity dangerous to be at large, and 

is a proper subject for the Insane Asylum; and the said being 

duly sworn, deposes and says that the foregoing statement is true; 
wherefore he prays that such action may be had as the law requires, and 
that the said may be sent to the Asylum of California. 

Subscribed and sworn to before me, this day of A. D. 

.86 . . 

The foregoing application having been made to me, , County 

Judge of said county, and named in said application, being this 

day brought before me for examination on said charge of insanity, and 

having heard the testimony of and witnesses who have 

had frequent intercourse with the accused during the time of the alleged 

insanity; and doctors and graduates in medicine, after 

hearing the testimony of witnesses, and after a personal examination of 
the accused, having made the certificate by law required, and being my- 
self satisfied that the said is insane and dangerous to be at large, 

and is not a case of idiocity, or imbecility, or simple feebleness of intel- 
lect, or old case of harmless dementia, or of any class of old, incurable, 
and harmless insanity, nor a case of delirium tremens; and being further 
satisfied of the truth of all the matters set forth in the said physician's 

certificate; I do hereby order the said to be taken to and placed 

in the Insane Asylum at Stockton, and is charged with the execu- 
tion of this order. 

As to the ability of the said or his kindred to bear the charges 

or expenses for the time may remain in the Asylum, as well as all 

other matters pertaining to interests or possessions, I find, after 

diligent inquiry the facts to be as follows: 

1. The said is by possession of able to pay 

expenses in the Asylum. 

2. I have appointed a guardian for the said and 

directed a quarterly payment in advance, and a supply of necessary 
clothing, together with the bond, to be forwarded to the Asylum with 
the said as by law required of paying patients. 

3. The said has kindred in the degree, as by law defined, 

who are able to pay said expenses, and I have made the assess- 
ment as by law directed in cases of kindred able to pay. 

4. There is due the said for and I have 

taken steps as by law required to be taken in such cases. 

5. There money (in own right) on the person of the said 

and 



Witness my hand this day of A. D. 186 . 

, Judge. 



PHYSICIAN S CERTIFICATE. 



State of California, County of 

We, and ■ being sworn, do depose and say that we are 

graduates in medicine; that at the request and in the presence of Hon. 
■, County Judge of said County, we have heard the testimony, and 



304 






carefully examined the said in reference to the charge of insanity, 

and do find that is insane and by reason of insanity dangerous to 

be at large. The facts in support of this opinion (elicited by said exami- 
nation) are set forth in the answers to the following questions as nearly 
as can be ascertained: 

QUESTIONS. 

1. Name? 

2. Age? . 

3. Nativity? 

4. Married or single? 

5. If children, how many, and the age of the youngest? 

6. If female and married, maiden name and name of husband? 

7. What State last from and how long in California? 

8. What occupation? 

9. What evidence have you of the presence of insanity? 

10. Is there a homicidal, suicidal, or incendiary disposition? 

11. Is the case a recent one, having occurred within twelve months 
last past. 

12. When did this attack first appear? 

13. Is this the first attack? If not, when did others occur and what 
their duration? 

14. Is the disease increasing, decreasing, or stationary? 

15. Are there rational intervals? If so, do they occur periodically? 

16. Is there any permanent hallucination? If so, what is it? 

17. In what way is the accused dangerous to be at large? 

18. Is there a disposition to injure others? If so, is it directed especi- 
ally to relatives, and is it from sudden passion or premeditation ? 

19. If suicidal, is the propensity now active, and in what way? 

20. Is there a disposition to filthy habits, destruction of clothing, fur- 
niture, etc.? 

21. Any relations, including grand parents and cousins, been insane? 

22. Any peculiarities of temper, habits, disposition or pursuits, before 
the attack — any predominant passions or religious impressions? 

23. Been intemperate in the use of ardent spirits, wine, opium or 
tobacco in any form? 

24. Suffered from epilepsy, suppressed secretions, eruptions, discharges 
•r sores, or injured on the head? 

25. Any change in the physical health since the attack? 

26. The supposed cause of insanity? 

27. Of what class of insanity? 

28. What treatment has been pursued, and with what effect? 

, M. D. 

, M. D. 

Subscribed and sworn to before me, this day of A. D. 

186 . . 






305 
DIETABY 

OF THE INSANE ASYLUM OF THE STATE OF CALIFORNIA, FOR EACH PATIENT. 

Breakfast. 

One pint coffee, or more, to satisfy appetite; five ounces loaf bread; 
one half pound thick mush, made with corn meal or cracked wheat, fla- 
vored with syrup. 

Dinner. 

One quart soup, made from good fresh meat and beans, rice or fresh 
vegetables; four and one half ounces meat without bone; five ounces 
loaf bread; one half pound potatoes; beets, carrots, miscellaneous vege- 
tables and fruits, grown on the Asylum grounds, are used when in 
season. 

Supper. 

One pint tea; five ounces loaf bread; three ounces gingerbread. 

The attendants are instructed to furnish as much bread and soup 
as the patient may desire, except in cases of dementia with morbid 
appetite. 

Patients employed on the farm and garden have a lunch of bread and 
butter at ten o'clock, a. m. and at four o'clock, p. m., in addition to the 
above. 

The diet of the sick is prescribed by their medical attendant. 

Different kinds of meats and fish are substituted for beef, and other 
variations made for a change occasionally, but not regularly, except 
Fridays, when fish is used as far as practicable. 



BICHMOND, NEAE DUBLIN. 

Ordinary Diet — Breakfast: half pound of bread and a pint of tea, or 
eight ounces of stirabout with a pint of new milk. Dinner: ten ounces 
of bread to males, and eight ounces to females, with half pound of meat or 
a British pint of soup. Supper: half pound of bread and a pint of cocoa. 

Extra Diet. — Breakfast, ordered by the medical officers, an egg. Din- 
ner: a pint of beer or porter, half pound of chops, or half pint of beef 
tea and eight ounces of bread. Supper: a British pint of tea and eight 
ounces of bread. 

Hospital Diet. — Beef tea, chops, eggs, wines, rice, arrowroot, etc. 



39 



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307 
EDIKBUBGH EOYAL ASYLUM. 

DIET TABLE. 

Breakfast for Males. 



Six ounces oatmeal or two pints of porridge, and three fourths pint 
of skimmed or buttermilk, or one fourth ounce of coffee; one half 
ounce of sugar; seven and a half ounces of bread, and one fourth ounce 
of butter. 

Females. 

Six ounces oatmeal or one and a half ounces of porridge, and three 
fourths pint of skimmed or buttermilk, or one fourth ounce of coffee; 
one half ounce of sugar; five ounces of bread, and one fourth ounce of 
butter. 

Dinner. 

Sunday — Four ounces of rice; one third ounce of sugar, and one half 
pint of sweet milk; seven and a half ounces of bread for males, and five 
ounces for females. 

Monday — Seven ounces of uncooked meat boiled in broth, with two 
ounces of barley; seven and a half ounces of bread, or one and one 
eighth pounds of potatoes, for males, and five ounces of bread, or one 
and one eighth pounds of potatoes for females. 

Tuesday — Seven ounces of uncooked meat, stewed or roasted, and 
eight ounces of vegetables, bread, or potatoes, as on Monday. 

Wednesday — Broth made with two ounces of meat boiled down in the 
broth; eight ounces of dumpling of flour, suet, and currants; bread or 
potatoes as above. 

Thursday — Seven ounces of uncooked meat made into Irish stew; 
bread or potatoes as above. 

Friday — Pea soup made from two ounces of meat and four ounces of 
peas; bread or potatoes as above. 

Saturday — Seven ounces of meat and broth, as on Monday; bread or 
potatoes as above. 

Supper for Males. 

Six ounces of oatmeal or two pints of porridge, and three fourths pint 
of skimmed or buttermilk, or one eighth ounce of tea; one half ounce 
of sugar; seven and one half ounces of bread, and one fourth ounce of 
butter. 

Females. 

One eighth ounce of tea; half ounce of sugar; five ounces of bread, 
and one fourth ounce of butter. 

Luncheon for Workers. 

Bread, two and one half ounces; cheese, one ounce; beer, one half 
pint. 



308 





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309 



GENEEAL EULES 

FOR THE 

SUEEEY COUNTY LUNATIC ASYLUM, 

AT BROOKWOOD, 

Pursuant to the fifty-third section of the Act 16 and 17 Vict. cap. 97. 



COMMITTEE OF VISITORS. 

1. The Committee of Visitors for the time being, shall meet for the 
first time at the asylum within a fortnight after their appointment, and 
shall then (after electing a Chairman), appoint five members of the 
Committee of Visitors to be a House Committee for the purposes after 
mentioned, of whom three shall be a quorum. They shall continue 
their meetings at the asylum throughout the year, by adjournment to 
such times as they shall consider most convenient. 

2. At their first meeting, and afterwards as occasion shall require, 
they shall make such appointments and perform such duties as may be 
necessary for carrying into full effect the various Acts of Parliament 
relating to lunatics (16 and 17 Yict. c. 97; 18 and 19 Yict. c. 105; 25 and 
26 Yict. c. 111). 

3. Minutes of the proceedings of the Committee of Visitors shall be 
kept and entered by the Clerk to the Visitors, and the same shall be 
read at the following meeting and sighed by the Chairman. 

4. The Committee of Visitors shall make, from time to time, such 
"regulations and orders " as they shall see fit, not inconsistent with the 
"general rules" for the time being, in force for the management and 
conduct of the asylum. 

5. No general rule for the government of the asylum shall be rescinded 
or altered, except at a meeting of the Committee of Visitors specially 
convened for the purpose; and no alteration in the general rules shall 
take effect until it has received the approval of one of Her Majesty's 
principal Secretaries of State. 

6. They shall cause all moneys received from every source to be paid 
to the account of the asylum at the bank of their Treasurer, and they 
shall make all payments by checks, to be signed by three of their body. 

7. A special meeting of the Committee of Visitors may be at any time 
convened in the manner pointed out by the Act 16 and 17 Vict, cap 97, 
sect. 25, notice being given of the particular business to be transacted 
thereat. 

8. They shall in addition to the report required by the Act 16 and 17 
Vict. cap. 97, sect. 62, present at every General Quarter Sessions of the 
Peace for the county a summary of their transactions during the preced- 
ing quarter; and at every Easter session they shall present a report on 
the state and condition of the asylum, with an audited account of the 
whole of their receipts and expenditures for the year ending on the pre- 
ceding thirty-first day of December. 



310 

HOUSE COMMITTEE. 

1. The House Committee shall visit the asylum twice in the course of 
every calendar month, and their duties shall be as follows: 

2. To inspect the food and see that all contracts are performed; also, 
to see all the patients and all the wards and premises appropriated to 
their use, and also to inquire and examine as to the convalescence and 
improvement of particular patients, and as to the treatment, health, and 
general condition of the whole establishment, and to perform the general 
duties imposed on them by the Act 16 and 17 Yict., cap. 97, sect. 61. 

3. To audit all the accounts of the asylum, to superintend the farm 
and garden, to examine all bills due by the asylum, and recommend the 
same when correct, for payment; to examine all accounts for the main- 
tenance of patients and for repairs previous to their being sent to the 
several parishes or to the County Treasurer, and to consider all applica- 
tions for additional stores and for advances to the Steward for current 
expenses before they are submitted to the Committee of Visitors, and 
also to make orders for such advances, not exceeding one hundred 
pounds sterling. 

4. To give orders, in all cases of emergency, for such works to be per- 
formed or such goods to be provided as shall be absolutely necessary for 
the service of the asylum, reporting such orders to the Committee of 
Visitors at their next meeting. 

5. To keep a record of all their visits and proceedings, and to make 
such reports or recommendations as they may see fit; all of which are 
to be read and confirmed at the next meeting of the House Committee 
and of the Committee of Visitors, respectively. 

CLERK TO THE VISITORS. 

1. There shall be a Clerk to the* visitors, who shall be considered the 
law officer and adviser of the Committee of Visitors, and shall prepare 
all contracts and legal documents. He shall convene and attend all 
general meetings of the Committee of Visitors, and also the meetings of 
the House Committee when required, and shall take minutes of all 
orders and resolutions, and take such steps as may be necessary for car- 
rying them into effect. 

2. He shall assist the visitors in their examinations of the asylum 
books of accounts, the quarterly abstract of expenditure or mainte- 
nance, and the accounts of the Treasurer, and in preparing the visitors' 
annual report for publication. 

3. He shall furnish to the Superintendent a copy of all orders made 
by the committee relating to the institution or its inmates. 

4. He shall transact all the ordinary duties of Clerk to the visitors as 
prescribed by the statute, and as may be directed by the committee. 

RESIDENT MEDICAL SUPERINTENDENT. 

1. There shall be a Medical Superintendent, who shall be a physician 
or surgeon and a registered medical practitioner. He shall be resident 
in the asylum, shall give up the whole of his time to the duties of his 
office, and shall not attend to or engage in any professional or other 
business or employment except that of the asylum. 

2. He shall have paramount authority in the asylum, subject to that 
of the Visitors; shall have control over all the officers, attendants, and 



311 

servants, and ,'jhall superintend and direct their duties as prescribed by 
the regulations and orders of the Committee of Yisitors. He shall be 
empowered to hire, suspend, or discharge all attendants and servants, 
subject to the approval and confirmation of the House Committee at 
their next meeting, when such hiring, suspension, or dismissal shall be 
reported. 

3. He shall be responsible for the condition of the patients, and for 
the management of the establishment, and shall have the full direction 
of the medical, surgical, and moral treatment of the patients, and of all 
general arrangements within the asylum. 

4. Should any ease of difficulty or danger arise, he shall have 
authority to call to his aid in consultation any registered medical prac- 
titioner. 

5. He shall visit the wards and offices daily, making occasional night 
visits also, and report to the House Committee any serious irregularities 
which may fall under his notice. 

6. He shall examine every patient shortly after admission, and shall 
cause proper entries relative thereto to be made in the books kept for 
that purpose. 

7. He shall regulate and determine the diet of the sick and infirm, 
and shall also from time to time examine and report on the quality of 
all provisions furnished for the use of the asylum. 

8. He shall regulate and determine the bedding and clothing of the 
patients. 

9. In all cases of fatal or dangerous accident, or other emergency, he 
shall immediately communicate the fact to the Chairman of the Com- 
mittee of Yisitors. 

10. He shall not absent himself for more than one night from the 
asylum, without the previous written consent of one of the Committee 
of Yisitors; nor for more than one week, without the sanction of the 
Committee of Yisitors or the House Committee; and on no occasion 
■shall he leave the asylum unless in charge of the Assistant Medical 
Officer, or of some other properly qualified medical substitute. 

11. He shall have power to exclude from admission into the asylum 
persons affected with cholera, or any disease or malady which may be 
considered contagious or infectious, and persons coming from any dis- 
trict or place in which any such disease or malady may be prevalent. 

12. He shall keep a journal, in which he shall record the name of 
every attendant and servant whom he shall hire, suspend, or dismiss, 
together with the date and cause of such hiring, suspension, or dismis- 
sal. Also the name of every patient fit to be discharged, or likely to be 
benefited by being allowed a period of absence on trial. Also the case 
of every escape, death, and inquest, with such particulars as may be 
necessary for the Committee of Yisitors to be made acquainted. Also 
all such other facts, observations, and suggestions as he shall deem 
important, relative to the condition or management of the asylum or 
the patients therein. And all such entries shall be read as part of the 
proceedings at the next meeting of the House Committee, or Committee 
of Yisitors, respectively. 

13. He shall make a yearly report of the number of admissions, dis- 
charges, and deaths during the year, and shall, in the same report, 
describe the general condition of the patients, the state and manage- 
ment of the asylum, and such other matters as he shall deem necessary 
or the Committee of Yisitors may direct. 



312 

ASSISTANT MEDICAL OFFICER. 

1. There shall be an Assistant Medical Officer, who shall be a member 
©f the Koyal College of Surgeons of London, Edinburgh, or Dublin, and 
a Eegistered Medical Practitioner. He shall be nominated to the Com- 
mittee of Visitors 01W his appointment by the Medical Superintendent, 
under whose control and direction he shall perform his duties. He shall 
be resident in the asylum and shall give up the whole of his time to the 
duties of his office. 

2. He shall not leave the asylum when the Superintendent is absent, 
at which time he is to be held responsible for the management of the 
Institution. In his own occasional absence, he shall conform to the 
directions he may receive from the Medical Superintendent, as to its 
duration and the period of his return. Should, however, he desire to be 
away from the asylum for more than one night, the written consent of 
some member of the Committee of Visitors must also be obtained. 

3. He shall exercise a general control over the conduct of the attend- 
ants and servants, and immediately report any misconduct, irregularity, 
or neglect of duty on their part to the Medical Superintendent. 

4. He shall have charge of the dispensary, and shall be responsible 
for the safe and proper custody of the drugs, surgical instruments, and 
appliances. 

CHAPLAIN. 

1. There shall be a Chaplain, who shall be a clergyman of the Church 
of England, in priest's orders, and shall be licensed by the bishop of the 
diocese. He shall devote the whole of his time to the duties of his office, 
and not hold any other engagement. 

2. He shall perform divine service, according to the rites of the 
Church of England, in the chapel of the asylum, every Sunday, Christ- 
mas day and Good Friday, preaching short sermons on each occasion. 

3. He shall administer the holy sacrament to such of the officers and 
servants as may be desirous of receiving the same, at least four times in 
a year, and to such of the patients as he may think advisable, with the 
approbation of the Superintendent. 

4. He shall consider all the household under his spiritual care. 

5. He shall attend daily at the asylum, and administer religious con- 
solation to the patients, subject however to the directions of the Com- 
mittee of Visitors and of the Medical Superintendent. 

6. He shall read morning prayers daily at such hours as the Commit- 
tee of Visitors and the Medical Superintendent may direct. 

7. He shall, under the general control and with the cooperation of 
the Medical Superintendent, organize and direct the schools for the 
patients of both sexes, and also classes for instruction in the Bible and 
in singing; and shall take charge of the library, and control the issue of 
books and periodicals. 

8. He shall keep a daily journal in which he shall enter the hours of 
his attendance, and such other particulars as it may be desirable for the 
Committee of Visitors to know, which journal shall be laid before the 
Committee at every meeting. 

9. He shall never absent himself from his duties on any Sunday, or 
for more than two days during the week, without leave in writing of 
one Visitor, and on providing some other clergyman, to be approved of 
by such Visitor, to supply his place. 



313 

10. He shall present an annual report to the Committee of Visitors, 
stating the result of his attendance on the patients. 

TREASURER. 

1. There shall be a Treasurer, to whom all monies shall be paid. He 
shall keep accounts of all monies received and jDaid by him and make 
them up to the thirty -first of December, annually, and state the balance 
(if any) then in his hands. 

2. He shall give security for a sum to be named by the Committee of 
Visitors. 

CLERK AND STEWARD. 

1. There shall be a Clerk of the Asylum, who shall act as Steward. 
He shall perform all the duties of both those offices, under the control 
and direction of the Medical Superintendent, to whom he shall imme- 
diately report whatever he may know to be improper or contrary to the 
rules in the economy of the house or conduct of the servants. He shall 
be resident in the asylum and shall give up the whole of his time to the 
duties of his office. 

2. He shall make all the necessary returns to the Commissioners in 
Lunacy and other authorities, as prescribed by the various Acts of 
Parliament relating to lunatics. 

3. He shall take care of all the books and papers (except those relat- 
ing to medical duties), and of all the stores, and shall be responsible 
for the quality, quantity, and safe keeping of all the articles received. 

4. He shall examine and superintend the weighing and measuring of 
all the goods and provisions furnished to the establishment, and imme- 
diately report to the Superintendent any failure in the quality or quan- 
tity thereof, -and take his instructions thereon. He shall order nothing 
except under the signature of the Superintendent, and receive nothing 
into the asylum without an invoice, which must be signed by himself 
in token of its correctness, and then filed. 

5. He shall superintend the weighing and measuring out of the pro- 
visions so as to suit the diet tables; he shall take stock once a quarter 
and keep quarterly accounts of all moneys received of and paid to the 
Treasurer, and also of all goods ordered and payments made for the 
same, in such form as the Committee of Visitors shall direct. 

6. He shall distinguish the building account from the maintenance 
account, and the accounts of the county from those of the unions and 
parishes; and shall lay an abstract of the accounts before the next 
meeting of the House Committee and of the Committee of Visitors, 
after the termination of each quarter, showing the moneys received and 
paid and the unions and parishes in arrear. 

7. He shall keep all such books of accounts, and in such forms as 
may be ordered from time to time by the Committee of Visitors, so as 
to show the true state of the accounts. These books shall be kept in 
his office and be subject at all times to the inspection of any member of 
the committee and of the Medical Superintendent, to whom he shall 
supply such financial and other information as he may from time to time 
require. 

8. He shall conduct such correspondence as the Medical Superintend- 
ent may direct, to whom he must submit all letters received by him 

40 



314 

relating to the asylum and its inmates, all of which letters are to be 
considered the property of the institution. He shall keep copies of all 
correspondence, whether replies to letters or otherwise. 

9. He shall keep inventories of all the household goods, furniture, 
farming and artisans' implements, official books, medical instruments, 
and other property of the institution. 

10. In his occasional absence from the asylum he shall conform to the 
directions he may receive from the Medical Superintendent as to its 
duration and the period of his return. Should, however, he desire to 
be away from the asylum for more than one night, the consent of some 
member of the Committee of Visitors must be obtained. 

11. He shall give satisfactory security by such sureties as the Com- 
mittee of Yisitors shall from time to time require. 

HOUSEKEEPER. 

1. There shall be a housekeeper, who shall perform her duties under 
the control and direction of the Medical Superintendent, to whom she 
shall immediately report whatever she may know to be improper or 
contrary to the rules in the economy of the house or conduct of the 
servants. She shall be resident in the asylum, and shall give up the 
whole of her time to the duties of her office. 

2. She shall have charge of the entire kitchen and laundry depart- 
ments, the officers' and servants' apartments, and central offices, and be 
responsible for their cleanliness and good order. She shall use her 
utmost endeavors to prevent waste, and to check any misapplication 
of stores. 

3. She shall have authority over the female servants, directing them 
in their several duties; and be responsible for the safety and conduct of 
all patients employed in any of the departments over which she has 
control. 

4. She shall superintend the preparation of the meals for the patients, 
officers, attendants, and servants, and shall see that the articles of food 
are properly cooked, and served with neatness and punctuality at the 
appointed hours. 

5. She shall superintend and be responsible for the washing, airing, 
and regular distribution of all articles sent to the laundry department. 

6. She shall receive from the steward once weekly all necessary 
materials to be converted into clothing, bedding, etc., for the establish- 
ment. She shall cut out and supply to the wards, through the head 
female attendant, all needlework necessary for the employment of the 
patients; and when made, return all the articles to the steward, stating 
their number, with a detailed account of the conversion of the raw 
material. 

7. In her occasional absence from the asylum she shall conform to 
the directions she may receive from the Medical Superintendent as to 
its duration and the period of her return. Should, however, she desire 
to be away from the asylum for more than one night, the written con- 
sent of some member of the Committee of Yisitors must also be 
obtained. 

HEAD ATTENDANTS — MALE AND FEMALE. 

1. There shall be a head male and a head female attendant, who shall 
perform their duties under the control and direction of and as prescribed 
by the Medical Superintendent, to whom they shall immediately report 



315 

whatever they may know to be improper or contrary to the rules in the 
economy of the house or conduct of the attendants. They shall give 
up their whole time and attention to the duties of their office. 

2. They shall instruct the attendants in the performance of their 
duties, and shall at all times require the strictest obedience to any 
orders which they may give. 

GENERAL MANAGEMENT. 

1. The male and female patients shall be kept in separate wards, and 
no male attendant, servant, or patient shall be allowed to enter the 
female wards, nor any female to enter the male wards, except in dis- 
charge of their duty, or with adequate authority. In visiting the female 
patients, the medical officer shall be accompanied by the head attendant, 
or some other female officer, and no male shall enter the female wards, 
unless accompanied by a female attendant. Any male attendant or 
servant found in any portion of the women's wards, unless he can give 
a satisfactory explanation for his being there to the Superintendent, 
may be immediately dismissed. 

2. There shall be such a number of attendants as shall be sufficient for 
the effective supervision of the patients, both by day and night; and no 
ward shall at any time be left without at least one attendant. 

3. During the day the patients of both sexes shall be employed as 
much as practicable out of doors; the men in gardening and husbandry, 
the women in occupations suited to their ability; and as a principle in 
treatment, endeavors shall be continually used to occupy the minds of 
the patients, to induce them to take exercise in the open air, and to 
promote cheerfulness and happiness among them. 

4. The male patients shall be encouraged to follow their particular 
callings, and to learn shoemaking, tailoring, and other common useful 
trades. Needlework, strawwork, and other suitable employments shall 
be provided for the female patients. And they shall be rewarded by 
such indulgences as the Superintendent may deem compatible with their 
welfare and encouragement. 

5. An ample supply of books, and cheap publications of a cheerful 
nature, in addition to Bibles and prayer books, shall be provided, and 
replaced in case of destruction; and various methods of in and out 
door amusements shall be placed at the disposal of the. patients of both 
sexes, and they shall be encouraged to have frequent recourse thereto. 

6. Ample and special provision shall be made for the effective watching 
of the asylum and attention to the patients during the night. 

7. No patient, on any account whatever, shall be struck, or threat- 
ened, or spoken harshly to; and no patient shall be placed in restraint 
or seclusion, or be subjected to any bath (except for the purpose of 
cleanliness), except by the authority of one of the medical officers. 

8. All the attendants shall be responsible for the safety, cleanliness, 
and general condition of the patients, and for the ventilation, proper 
warmth, and good order of their respective wards. 

9. No officers, excepting the Treasurer and the Clerk to the Visitors, 
shall have any occupation unconnected with the asylum, nor shall they 
have any interest, directly or indirectly, in any other establishment for 
the reception and treatment of lunatic, imbecile, or idiotic patients. 

10. No officer, attendant, or servant shall, directly or indirectly, take 
any fee, reward, or perquisite of any kind from any tradesman, patient, 
or other person, on pain of immediate dismissal. 



316 

11. Eelatives and friends of patients shall be allowed to visit them 
once in every week, between the hours of ten and four o'clock, and on 
such other days and hours as the Superintendent shall in special cases 
permit; but no visitor shall be permitted to see any patient if the Super- 
intendent shall state in writing that the visit will be injurious to the 
patient or otherwise inexpedient. 

12. Patients shall be at liberty to hold private conversation with 
those who visit them, but no male visitor shall remain in a room with a 
female patient, nor a female visitor with a male patient, except in the 
presence of an attendant or other third person. 

13. The person of every patient shall immediately after admission be 
carefully examined by the head attendant, who shall at once personally 
report in writing, to one of the medical officers the bodily condition of 
the patient, and especially of any mark, bruise, or injury of any kind, 
bedsores, ruptures, or the slightest symptom of disease or disorder of 
any kind; and it shall be the duty of one of the medical officers, upon 
receiving notice of the existence of any injury or apparent bodily dis- 
order, at once himself to make a personal examination of the patient; 
and no relieving officer or other person bringing a patient to the asylum 
shall be allowed to leave the premises until such report or examination 
shall have been made. 

14. All parish officers shall be encouraged to visit the patients be- 
longing to their union or parish once in every three months, or oftener, 
on a week day; and to make particular inquiries from time to time as to 
the treatment experienced by the patients, and their fitness for dis- 
charge. 

15. Notice shall be given to the nearest relative in the case of serious 
illness to any patient, and especially where a fatal termination is antici- 
pated. On the death of a patient, notice shall be immediately given to 
the coroner of the district, the parish officers, the registrar of the dis- 
trict, and the nearest relations of the deceased (if their address be 
known), and the body shall be delivered to the latter if requested. If 
the body be not removed early on the fourth day after death, it shall 
be buried under the direction of the Superintendent, who shall have 
power to order an earlier interment, if from any particular circumstance 
he shall consider such to be necessary. 

16. Such patients as the Superintendent may direct shall in such 
number and at such times as he may think fit, be allowed, under proper 
care, to take walks or excursions beyond the grounds of the asylum; 
and he shall also be empowered, at his discretion, to permit patients to 
spend the day with their friends. 

Approved. 

(Signed) GATHOJ&NE HARDY. 

Whitehall, 28th October, 1867. 



317 



PEOPOSED CASE BOOK— (ENGLISH). 

Name. Admitted. 

Age and Sex. State as to Marriage. 

"Where from. Occupation. 



Education. 
Eeligion. 



History , 



Causation 



( Previous attacks, 
j Hereditary history. 
I Predisposing. 
^ Exciting. 



"Where treated. 
Disposition and 
health. 



habits in 



Duration of Disease. 

First f Mental. 
Symptoms. ( Bodily. 



Recent ' 


' Mental. 

Bodilv. 




Symptoms. ( Suk .. JaJ 


Dangerous. 


Other facts. 




State on Admiss 


ion. 




' Exaltation. 






Depression. 






Excitement. 






Enfeeblement. 




Mind. 


Memory. 
Coherence. 

Can answer questions. 
Delusions. 
k Other abnormalities. 

'Appearance. 






Color of hair. 


Color of eyes. 




Muscularity. 


Fatness. 




Nervous system. 






Eeflex action. 


Pupils. 




Special senses. 


Eetina. 


Body. < 


Lungs. 






Heart, 


Pulse. 




Other organs. 






Tongue. 


Appetite. 




Urine, specific gravity. 


Urinary deposits 




Menstruation. 


Temperature. 




LHight. 


Weight. 



Name of Disease. 



General Bodily State, 



318 



Date. 



Temperature. 


Pu 


se. 


Weight 


Morn'g 


Even'g 


Morn'g 


Even'g 













Progress of Case. 



[Memoranda to be put in beginning of Case Book.] 
HISTOEY. 



Previous Attacks. 
Hereditary History. 



Predisposing Causes. 



Exciting and Proximate 
Causes. 



Number, character of each. 

Age of parents, relationship of parents or 
grand parents, health of same, family dis- 
eases or peculiarities — consumption, epilepsy, 
drunkenness. 

Drunkenness, overwork, character of vocation 
or habits. Food, tobacco, tea, infantile dis- 
eases, adult diseases. Catamenial irregular- 
ities, marriage, children, difficult labors, mis- 
carriages, lactation, etc. 

Disease of brain emotions — blows on the head, 
drinking bouts, fever, poisons, over-sexual 
excitement, childbirth. 



STATE ON ADMISSION MOKE FULLY AND SYSTEMATICALLY 

AEEANGED. 



A. — Bodily Condition. 



a, Hight. 

b, Weight. 

c, Temperature. 

d, Color of hair (baldness). 

e, Muscularity. 
/, Fatness. 

g, Expression of face and general appearance. 

h, Any special injuries or wounds to be noted. 






JB. — Vegetative Func- 
tions. 



Digestive 



Tongue, stomach, appetite, con- 
dition of bowels. 

b, Dermic — Conditions as to moistness, erup- 
tions, and other abnormalities. 

c } Circulatory — Pulse, cardiac murmurs, flush- 
ing of face, or inject of conjunctiva. 






TIONS. 



D. — Nervous System. 



319 

d, Respiratory — State of lungs, breath, rapid- 

ity of respiration. 

e, Glandular — Exam, of urine, state of liver, 

spleen, thyroid, etc. 

C. — Reproductive Func- a, Abnorm. of penis or testes in men — mas- 
turbation, syphilis, etc. 

b, In women — Catamenia, discharges, syphili, 
pregnancy, nursing, etc. 

a, Paralysis, epilepsy, catalepsy, hysteria, and 
other abnormalities unconnected with the 
special senses or mental functions. 

b, Special senses — 

1. — Sight — a, Color of iris. 

b, Shape and size of pupils. 

c, Condition of retina. 

d, Vision. 

e, Knowledge of color. 
/, Hallucinations. 
g, Illusions. 

2. — Hearing — a, External ear. 

b, Deafness. 

c, Hallucinations. 

d, Illusions. 

3. — Smell — a, Any abnormality of nose. 

b, Sense of smell. 

c, Hallucinations. 

d, Illusions. 

4. — Taste — a, Sense of. 

b, Hallucinations. 

c, Illusions. 



E. — Mental Symptoms, 
unconnected with the 
special senses. 



5. — Touch and Nervous Sensibility — 

a, Sense of pain. 

b, Eeflex action. 

c, Hyperesthesia. 

d, Illusions and hallucinations, in- 

cluding those of internal or- 
gans. 

a, Apparent consciousness. 

b, Identity. 

c, Attention. 

d, Coherence of language. 

e, Memory — a for recent events, b for past 

ditto. 
/, Exaltation or depression of spirits. 
g, Excitement of manner. 



320 

h, Habits and propensities (filthy, dangerous, 
suicidal, destructive, indecent, etc.) 

i, As to sleep. 

j, Delusions — not being hallucinations or illu- 
sions. 

k, Other abnormalities. 



NOYA SCOTIA CASE BOOK. 

Eegistered No. Previous Nos. 

Name 

Admitted — 
Where from 
Brought by 
Order of 
Maintenance 
Certificates 

Age last birthday 

Sex state as to marriage 

Occupation 
Natural disposition 
Habits in health 
Education 
Eeligion 
Address of nearest friend 



HISTORY. 



Age at first attack 
First ) Bodily 
Symptoms j Mental 
No. and duration J 
of previous attacks ( 
Where treated 

f Hereditary history 
Causation < Predisposing 

(_ Exciting 
Duration of present attack 

'Recent ") Bodily 
Symptoms j Mental 
Suicidal, and how 
Dangerous, and how 
Other facts 






321 



Name, 



Date. 



Temperature. 



Morn'er Even'g; 



Pulse. 



Morn'g Even'g 



Weight 



Progress of Case. 



MICHIGAN ASYLUM FOE THE INSANE. 

SITUATION. 

The Michigan Asylum for the Insane is situated at Kalamazoo, upon 
the Michigan Central Eailroad. The location is probaby as central and 
convenient as any that couid have been chosen, having reference both 
to the present means of communication with the various parts of the 
State, and to any other routes of travel likely to be projected hereafter. 
The site selected for the building is upon an irregular eminence, about 
one mile from the village, and sufficiently elevated above the valley of 
the Kalamazoo River to secure an extensive prospect, and yet is well 
sheltered and easy of access from the plain below. The location is in 
every respect healthful and desirable, and well adapted to the purposes 
and objects of an institution for the treatment of mental diseases. 

FARM. 



The amount of land originally purchased for the use of the asylum, 
was one hundred and sixty acres, but to secure a more desirable site 
for the buildings, an adjacent tract was subsequently added, making the 
whole amount of land in the possession of the institution one hundred 
and sixty-eight acres (167 76-100). Most of the land is finely timbered 
with the original growth of oak, hickory, and other trees, affording 
every facility which could be desired for beautifying the grounds. That 
in the rear of the building is broken, and falls, by a series of ravines 
covered with trees, about eighty feet to the valley below, through 
which flows a small but rapid stream of pure water. The buildings 
themselves will cover an area of one and one third acres. It is designed 
to preserve about fifty acres in groves and woodland, with walks and 
drives, and the remainder will be devoted to ordinary agricultural pur- 
poses. 

41 



322 

GENERAL PLAN. 

The ground plan was furnished by Doctor John P. Gray, the accom- 
plished Superintendent of the New York State Lunatic Asylum at Utica, 
under whose directions the work was commenced. It might here be 
remarked that the principles laid down in a series of propositions rela- 
tive to the construction and arrangement of hospitals for the insane, 
unanimously adopted by the "Association of Medical Superintendents of 
American Institutions for the Insane," have been fully carried out in the 
plans adopted by the Board. The form and internal arrangements of 
the institution will be readily understood by reference to the accom- 
panying ground plan. The asylum building proper, the main front of 
which has an easterly aspect, consists of a centre and six wings. The 
centre portion of the main building is divided by the entrance hall into 
two nearly equal parts. That to the right contains, in front, the princi- 
pal office of the institution, the apothecary shop, and an anteroom com- 
municating by a private stairway with the Superintendent's apartments 
above, and in the rear the matron's room and ladies' reception room; 
while that to the left contains, in front, the public parlor and officers' 
dining room, and immediately behind these the steward's office and 
men's reception room. The second floor is appropriated exclusively to 
the use of the Medical Superintendent. Upon the third floor are the 
apartments of the Assistant Physicians, steward, and matron. The base- 
ment contains the laboratory connected with the apothecary shop, and 
the officers' kitchen and storerooms. Immediately behind the centre 
building is the chapel, and still further in the rear the engine and boiler 
house. Extending from the centre building toward the south for males, 
and toward the north for females, are the several wards of the institu- 
tion, nine on each side, including the infirmaries. 

MATERIALS. 

The material used in construction is brick, covered with Roman cement 
and sand, and finished to represent freestone. The window caps, sills, 
and brackets, belt courses, and capitals in front, are of white limestone 
from the Athens quarries, near Chicago. The division walls throughout 
are of brick. The Asylum is built upon a system of fireproof construc- 
tion, nearly all the floors being laid upon brick arches sprung from iron 
girders, which, beside providing against fire, give additional security to 
the building and insure its durability. 

ARCHITECTURE. 

The plans selected by the Board of Trustees were placed in the hands 
of A. H. Jordan, architect, of Detroit, for the necessary elevations, 
details, etc. The style adopted is the Italian, it being the lightest, most 
cheerful, and least expensive for the effect required in such an extensive 
range of buildings. 

REFERENCES TO THE PLATE. 

(A) public parlor; (B) general office; (C) Matron's room; (D) Stew- 
ard's office; (E E") reception rooms; (F) officers' dining room; (G) 
apothecary shop; (H) anteroom, communicating by a private stairway 
with the Superintendent's apartments above; (I) Steward's storeroom; 






323 

(J J) matron's storerooms; (K) associated dormitories; (L) attendants' 
rooms; (M) day and recreation rooms; (N) parlors; (O) dining rooms; 
(U) chapel, having below it the kitch'en and storerooms; (1) boiler 
house; (2) engine and fanrooms; (3) laundry; (4) drying room; (5) 
ironing room; (6) work shops; (7 7 7) covered corridors. 

APPROPRIATION OF WARDS. 

The various wards in the institution are appropriated as follows: 



Nos. 



Classification. 



No. of 
ward* . 



Number of beds. 



Single 
rooms. 



Associated 
dormit's. 



1 8, 

P J3 



1 and 2 
3 and 4 
5 and 6 

7 

8 ■ 
9 



Convalescent and quiet 

Less disturbed 

More disturbed 

Demented 

Demented and infirm 

Acute cases, etc., (Infirmaries) 

Total 



80 
56 
60 
20 
12 
12 



16 
32 



18 



240 



96 
88 
60 
20 
12 
12 



288 



The divisions for the sexes are equal. Eight of these wards, inclusive 
of the infirmaries, are upon the first floor, six upon the second, and four 
upon the third floor of the transverse wings. It is considered that by 
means of these any desirable classification of patients may be carried 
out. 

ARRANGEMENT OF WARDS. 



Each ward has the usual arrangement of corridor, sleeping rooms, 
day rooms, and dining room, with two stairways, a clothes room, lava- 
tory, bath room, water closet, soiled clothes shaft, drying shaft, and dust 
flue to each. The corridors in the first, second, and third wings are, 
respectively, one hundred and fifty-five, one hundred and sixty, and sev- 
enty feet long, and in the third stories of the first and second transverse 
wings, one hundred and nineteen and thirty-four feet long. They are 
uniformly twelve feet wide, and, in common with all other rooms, sixteen 
feet in height upon the first and third floors, and fifteen upon the second. 
The dimensions of the single sleeping rooms are eight and ten by eleven 
feet, with an average cubic capacity of fourteen hundred feet. The 
associated dormitories are fourteen by twenty-one feet, and the parlors or 
recreation rooms, eighteen by twenty. Lateral recesses, extending into 
the projecting towers in front, form additional day rooms in the first 
and second wings on either side. The dining rooms are sufficiently capa- 
cious to accommodate the number for which they are intended, and are 
supplied with detached sinks, cupboards, and dumb waiters. The clos- 
ets, bath rooms, lavatories, and clothes rooms open upon an adjacent and 
not upon the main hall, giving a very desirable privacy. The bath and 
closet fixtures are of approved construction, and, to prevent all possible 



324 

danger from leakage, the service pipes are conveyed in a separate pipe 
shaft — an arrangement which also facilitates and cheapens any repairs 
that may become necessary. Drying shafts, having lattice-work floors 
and communicating directly with the ventilating cupolas, furnish a ready 
means of drying mops, wet cloths, damp brooms, etc., and thus mate- 
rially assist in promoting the cleanliness and healthfulness of the cor- 
ridors. To prevent exposure, the bathrooms and lavatories have 
communicating doors, in order that the latter may serve, on " bathing 
days," as dressing rooms to the former. 

INFIRMARIES. 

In a detached building, in the rear of the first transverse wings, but 
connected with the wards by means of a covered corridor, an infirmary 
is provided for each sex. Fitted up with every convenience, they provide 
a very desirable place for the treatment of acute cases, of those who 
are seriously ill, or of any requiring special care and frequent medical 
attention. They can be reached at all hours of the night without dis- 
turbing any other portion of the house; they provide the means of isola- 
tion in case of the occurrence of any infectious or contagious diseases 
in the institution, and give to the friends of dying patients an oppor- 
tunity of administering to them in their last moments. 

WINDOWS. 

The windows are fitted throughout with a castiron sash, the upper 
half of which alone is glazed. Posterior to the lower half, and immedi- 
ately against it is a wooden sash of corresponding size and shape, moving- 
free and suspended by a cord and weight; the former being attached to 
the bottom of the sash and passing over a pulley near its top, is always 
entirely concealed. The panes of glass are six by nine inches in size. 
The windows, where deemed desirable, are protected by a shutter of 
framed wicker wJbrk, sliding into the wall and retained there, as also in 
its position, by one and the same lock. 

FLOORING. 

The floors in all uncarpeted rooms are formed of one and one half 
inch oak plank, grooved and tongued, and none of them being more 
than three and one half inches in width. The sleepers and the iron 
girders supporting the arches rest upon an offset in the wall, which, 
when finished, also forms the cornice in the room below. 

PROVISION AGAINST FIRF. 

The horrible sacrifice of human life on the occasion of the burning of 
an institution for the insane in one of the eastern States, and the pecu- 
liar liability of these buildings to take fire, as shown by the frequent 
occurrence of such accidents, determined the Board of Trustees, although 
it would somewhat increase the price of construction, to make the asylum 
fireproof. The more recent partial destruction by fire of another insti- 
tution has confirmed the wisdom of this decision. The use of iron gird- 
ers and brick arches as a support for the floors was consequently deter- 
mined upon, and to secure additional safety all connection between the 
wings and the center building is entirely cut off by the interposition of 



325 

a verandah of iron and glass, with communication from one to the other 
only through fireproof doors. The location of the heating apparatus 
and the kitchen, in detached buildings, renders the institution quite 
exempt from danger of destruction by fire. 

CHAPEL. 

A separate building immediately in the rear of the centre building, 
seventy by forty feet in size, contains upon its first floor a room for 
chapel purposes capable of seating three hundred and eighty persons. 
It communicates with the different wards by means of covered corridors, 
is appropriately fitted up, properly warmed, and lighted with gas. 

KITCHEN. 

One central kitchen is intended to supply the whole institution. It is 
placed immediately beneath the chapel room, with storerooms near at 
hand, and communicates with the dumbwaiters of the different dining- 
rooms by means of a small car moving upon a covered railway. The 
building containing the chapel room and kitchen is surmounted by a bell 
and clock tower. 

WARMING AND VENTILATION. 

It is now admitted, as a principle, that the warming and ventilation of 
buildings corresponding in size and purpose with institutions for the 
insane should be effected by one and the same process; and also that 
means should be adopted for expelling the foul air to the same extent 
and simultaneously with the admission of fresh. The fact is also estab- 
lished, and in many asylums has been confirmed by a costly experience, 
that the ordinary system of making the ventilation depend upon the 
spontaneous action of warm-air currents failed to give satisfactory 
results. A perfect and equable distribution of fresh air, either warm or 
cold, and the necessary rapidity in the discharge of foul air, under all 
circumstances and in all seasons, can be secured only by a system of 
forced ventilation. This is found to be most efficiently and economically 
effected by means of a fan driven by a steam engine — effectual, because 
at all times under perfect control; and economical, because the warm 
air is more thoroughly and rapidly distributed. The primary cost is 
not great; it is not liable to get out of order, and the motive power is 
that required for other purposes. The system decided upon is a modifi- 
cation of that in use at the New York State Lunatic Asylum, the effi- 
ciency of which is shown by the fact that in five similar institutions in 
other States it has since been adopted in place of furnaces and other 
means of heating and ventilation already in operation. It consists of 
boilers, an engine, a fan, heating surface, and distributing ducts, and 
inlet flues, with exit flues, foul air ducts, and ventilating cupolas. The 
boilers are four in number; these, with the engine and fan (the latter 
peculiar from the circumstance of its delivering the air in the direction 
of its axis), and the heating surface, consisting of a series of wrought- 
iron pipes, are all in a separate and detached building. The air, after 
its delivery from the fan, passes directly forward beneath the chapel. 
The main duct conveying it gives off a small branch to the chapel, and 
another to the centre building; it then branches toward either wing, and 
another subdivision is made, one portion passing beneath the first longi- 



326 

tudinal wing, and the other, entering the proximal end of the second 
wing, passes on to the end of the extreme wing. The air passage 
beneath the building occupies the middle portion of the basement, or 
rather the space immediately beneath the floors of the corridors, and 
the distributing flues pass up in the walls upon either side of them. 
Exit flues are carried up in the same walls, taking their departure from 
two points, one near the ceiling, and the other near the floor of the 
rooms on either side; these again conjoin in the attics to form the foul 
air ducts and empty out into the open air through the ventilating cupolas. 
Downward currents of air, for the ventilation of the water closets, will 
be secured through an arrangement of pipes terminating in the fire 
boxes of the boilers. 

LAUNDRY AND WORKSHOPS. 

The right wing of the engine and boilerhouse contains the washroom, 
drying and ironing rooms; and a similar wing upon the other side fur- 
nishes convenient rooms for the usual workshops. A close partition 
running from the rear of the chapel to the engine house, with a covered 
passageway on either side, provides ready and protected access to the 
shops and ironing rooms from the various wards in the house, and at 
the same time prevents all communication between the sexes. 

WATER. 

Water for drinking purposes is drawn from a well, while that for 
bathing and laundry purposes is forced up from a stream flowing in the 
valley, immediately in the rear of the institution. 

DRAINAGE AND SEWERAGE. 

Cast iron pipes will be used for connecting drainage in the rear of the 
wings, and will pass forward beneath the building at a single point only 
on either side. The drains and branch sew T ers will unite in front, and 
pour into the common sewer, which is of brick, egg-shaped, three feet 
high, and two feet wide. This runs down the ravine in front of the 
institution, and empties into a depot for the collection of solid material. 

ILLUMINATION. 

It is now universally conceded that gas is the only proper material to 
be used in lighting asylums for the insane. To obviate the only objec- 
tion to its manufacture upon the premises, the gashouse will be placed 
just below the depot referred to. The gas main will be carried up to 
the institution in the sewer, attached to its upper arch. 

The completeness of this description renders any further analysis of 
the internal arrangement of the institution quite unnecessary. To those 
familiar with the construction of asylums for the insane a reference to 
the engraving and lithograph will supply any omission that may have 
occurred. The plans of the building, as given in the preceding sketch, 
have been submitted to and received the unqualified approval of many of 
the more experienced physicians in charge of similar institutions; and 
from those most capable of judging, the Board have received the grati- 
fying assurance that their efforts to combine in one the acknowledged 
excellences of several recently erected establishments, with such 



327 

improvements as careful study and experienced assistance suggested, 
have not been unsuccessful. 

EXPLANATIONS OF THE PLATE. (App. F.) 

In the accompanying plate, all portions of the institution represented 
in shaded lines % are already built, with the exception of the "Infirmary 
for Males" and the chapel and kitchen. The portions represented in 
outline constitute, collectively, the north wing. 

"Hall No. 1" constitutes the portion known as the first longitudinal 
division. Adjoining it at the left is the first transverse division, which 
is connected with the second transverse division by the second longi- 
tudinal, designated as "Hall No. 3." "Hall No. 5 " and the wards 
beyond it are collectively known as the extreme wing. The transverse 
divisions are three and all other portions of the wing two stories high. 
The divisions of the north wing are the same. 

References. — A, Trustees' room; B, general office; (j, Matron's room; 
D, Steward's office; E, E, reception rooms; F, dining room; G, medical 
office; H, safe on the left and water closet on the right; K, associated 
dormitories; M, recesses; N, day rooms ; O, ward dining rooms; IT, chapel 
and kitchen; 1, boiler room; 2, engine room; 3, laundry; 4, drying room; 
5 and 6, ironing and distributing rooms; 8, fan room. 



PENNSYLVANIA HOSPITAL FOR THE INSANE. 

The Pennsylvania Hospital for the Insane, as now constituted, con- 
sists of two distinct buildings, each complete in itself, having separate 
pleasure grounds and inclosures, both situated, however, on the same 
tract of one hundred and thirteen acres of land originally purchased 
by the institution. The hospital just completed is styled "the Depart- 
ment for Males," and that which has been in use during the last nine- 
teen years, "the Department for Females." Both departments remain 
as heretofore under the charge of a Physician in Chief, and who now 
has as associate officers one or more assistant physicians, a steward, and 
a Matron in each building. 

This new hospital faces to the west, and consists of a centre building, 
with wings running north and south, making a front of five hundred and 
twelve feet; of other wings, connected with each of those just referred to, 
running east a distance of one hundred and sixty-seven feet, all three 
stories high, and these last having at their extreme ends communications 
with extensive one-storied buildings. All the exterior walls are of stone, 
stuccoed, and the interior are of brick. 

This arrangement gives provision for the accommodation of sixteen 
distinct classes of male patients in the new building, as the same num- 
ber of classes of females are now provided for in that previously in 
use. Each one of these sixteen wards has connected with it, besides 
the corridors for promenading and the chambers of the patients and 
attendants, a parlor, a dining room, a bath room, a water closet, a 
urinal, a sink room, a wash room, a drying closet, a storeroom for 
brushes and buckets, a clothes room, a dumb waiter, a dust flue, and a 
stairway passing out of doors, if desired, without communication with 



328 

the other wards; and every room in the building, almost without excep- 
tion, has a flue communicating with the fresh air duct for warm or cool 
air, according to the season (and hereafter to be referred to), and with 
the main ventilating trunks which terminate in the various ventilators 
on the roof of the building. 

The centre building is one hundred and fifteen by seventy -three feet. 
It has a handsome Doric portico of granite in front, and is surmounted 
by a dome of good proportions, in which are placed the iron tanks from 
which the whole building is supplied with water. The lantern on the 
dome is one hundred and nineteen feet from the pavement, and from it is 
a beautiful panoramic view of the fertile and highly improved surround- 
ing country, the Delaware and Schuylkill Rivers, and the City of Phila- 
delphia, with its many prominent objects of interest. In the basement 
or first story of the centre building is the main kitchen, forty-two by 
twenty-four feet, in which are improved arrangements for cooking — a 
scullery, twenty-four by eleven; two storerooms, each about twenty by 
twenty-two feet; a trunk room, twenty-four by twelve feet; a general 
clothes room, a bread room, a dining room for the officers, another for 
the domestics, a lodging room for the seamstress, another for the super- 
visor of the basement, a stairway to the main story, and a dumb waiter 
leading from the kitchen to the cellar, and another to the upper rooms 
of the centre building. The cellars under the centre building, besides 
containing the hot air chambers for that division of the house, have 
three distinct rooms for storage, which are ventilated by means of flues 
leading out through the roof of the house. In front of the basement 
and under the steps and adjoining roadway are the vaults for coal for 
the kitchen and bake room, and the ice house, the Latter being ventilated 
as mentioned for the cellars; and carts unload into both, through open- 
ings in the blue stone flagging, which forms the roadway upon the arches 
below. Adjoining the ice house is a small apartment with stone shelves, 
for keeping food cool in Summer; and alongside the coal vault is a space 
for the offal from the kitchen. There is also a small kitchen near the 
scullery, and intended for the Superintendent's family, whenever it is 
required for the purpose. In one of the storerooms is a dark apartment, 
and in another the tanks for the oxygen and hydrogen gases used in the 
dissolving apparatus. 

On the second or principal story is the lecture room, forty-two by 
twenty-four feet, in the lecturer's table of which, water, steam, and gas, 
for experimental purposes have been introduced. It also contains com- 
modious cases for apparatus, a blackboard running on a track behind 
the cases, and a smooth surface twenty-four by eighteen feet, at its 
eastern end, on which the dissolving views are shown. On the opposite 
side of the main corridor is a reception room for visitors, and a room for 
visits to patients by their friends, each being twenty-four by twenty- 
three feet. There are also on this floor two small rooms for more pri- 
vate visits, the medical office and library, which is also the Assistant 
Physician's office, twenty-four by fourteen feet, with a small storeroom, 
containing a sink, etc., adjoining; the lodging room for the Assistant 
Physician having charge of the medical office, with which it communi- 
cates; a general business office, which is also that of the steward, twenty- 
four by twenty feet; a manager's room, twenty-four by nineteen feet, 
which is also the Principal Physician's private office; a parlor twenty- 
four by nineteen feet, for the use of the officers of the house, and a firer 
proof, eleven by nine feet, in connection with the general business office. 
In the third story front are four fine rooms, each twenty-four by twenty- 



329 

one feet; a corridor, forty -two by sixteen feet, shut off from the adjoin- 
ing portion by a ground glass partition; a bathing room, water closet, 
and clothes closets, intended at some future day for the use of the 
family of the superintending physician, whenever such an officer may 
be specially connected with that department. There are also on this 
floor, chambers for the Steward and Matron, for the Senior Assistant 
Physician, three others that may be used as deemed expedient, and a 
room twenty-four by eleven feet, lighted from the roof, and intended for 
a general storeroom for the bedding and other dry goods not actually in 
use. The corridors of the centre building, running east and west, are 
sixteen feet wide; those running north and south, in which are the 
stairways, lighted from the roof, are twelve feet wide. The height of 
the ceiling of the basement in the centre building, and of all parts of 
the wings, which is one foot more, is twelve feet. The ceilings in the 
second or principal and in the third story of the centre, are eighteen 
feet high. 

The wings on each side of the centre building are almost exactly 
alike, except that on the south side in front, in the basement immediately 
adjoining the centre, is the ironing room, twenty-eight by eleven feet, 
with a drying closet, eleven by eleven feet, attached, and in the rear the 
small kitchen already referred to, and the lodging rooms of the female 
domestics; while on the north side in corresponding positions, are the 
bake room, the baker's store and lodging rooms, and the lodging room 
of the hired men not employed in the wards. On this floor on each side 
of the centre is also a museum and reading room, forty-two by fourteen 
feet, and accessible either from the grounds or from the inside of the 
building; two work rooms for the patients; two lodging rooms for per- 
sons employed in the work rooms; a bath room for the officers, and 
another for the domestics; two water closets, etc. The portion of the 
wing just described is shut off from the adjoining part (which constitutes 
the fifth ward) by a thick ground glass partition; this ward having in 
it a large room, twenty -nine by twenty-four feet, with a bath tub and 
water closets in a recess; another twenty-four by fourteen feet; a third 
twenty-three by eleven feet, and five rooms eleven by nine feet, a bath 
room, drying closet, and all the other conveniences already mentioned as 
forming a part of each ward. These apartments and arrangements are 
all intended for patients who are particularly ill, and who require special 
quiet and seclusion, where they may be visited, if deemed expedient, by 
their friends without annoyance to others, or interfering with the dis- 
cipline of the house. 

Besides the fifth ward, just described, and which is on the first floor, 
there are, on each side of the centre, two other stories, each of which 
constitutes a ward, and with all the conveniences already referred to. 
The rooms are arranged on both sides of the corridors, which are twelve 
feet wide, and have their extreme ends mostly filled with glass; while, 
wherever one wing joins another, there is entirely across it an open 
space for light and air eight feet wide, glazed with small sash from near 
the floor to the ceiling; and in the middle of each ward, on one side, is a 
similar open space, all of which may be used for keeping flowering 
plants, birds, etc., for having small jets of water, or any other object of 
interest, and which, in excited wards, may be guarded by ornamental 
wire work. Each story of the return wing makes a ward similar to 
those just described. Passing from the return wings into the Super- 

42 



330 

visor's office, the one-storied buildings are reached. Each of these has 
provision for twenty-six patients and six attendants, and every arrange- 
ment for their comfort. The rooms are here on one side of a corridor 
ten feet wide, and at the end of each of those running towards the east 
is a cross hall, in which are three rooms intended particularly for pa- 
tients who from any cause may require special seclusion. One of the 
main halls is used for dining, and the oth^r as a sitting room. Between 
the dining halls of these two wards (the seventh and eighth), and made 
private by sliding doors, are four rooms intended for excited patients 
who have special attendants. Opposite these last is a room one hun- 
dred and ten by fourteen feet, with an arched ceiling fifteen feet high, 
with skylights and windows out of reach, intended to be used as a kind 
of gymnasium, and accessible either from the adjacent garden and yards, 
or directly from the wards; and in the story below this is a room of the 
same size, in which are two fine bowling alleys, with reading tables, etc. 
Both these rooms may be well lighted with gas, and warmed by steam 
pipe, so that they can be comfortably used in the evening as well as by 
day, and in all kinds of weather. 

The arrangement of these one-storied buildings makes for each two 
very pleasant yards, in size one hundred and ten by fifty-four feet, sur- 
rounded by broad brick pavements, and having grass in the centre, with 
an open iron palisade in front, giving a distinct though sufficiently dis- 
tant view of two of the most traveled roads in the vicinity. There is 
also a yard, three hundred and forty -three by seventy -two feet, adjoin- 
ing each sixth ward, fitted up as the others, and planted with shade 
trees. Brick pavements also surround the entire building, making, with 
those just referred to and those in front, a continuous walk of six thou- 
sand one hundred and fifty-two feet. 

ENTRANCE. 

The entrance to the department for males, as before mentioned, is 
from Forty-ninth street, between Market and Haverford streets. The 
gatekeeper's lodge has two comfortable rooms on the north, while on 
the opposite side of the gateway is a dead room and another for tools 
used about the grounds. Brick paths on either side of the main road- 
way lead to the centre building, and the space in front, planted with 
evergreen and ornamental trees, and having a fountain in the central 
grassplat, is three hundred and twenty-five by one hundred and seventy- 
five feet. From the front platform, eight steps lead up to the vestibule 
and seven steps inside of the building to the level of the principal floor. 
Visitors passing into the centre building may go out upon a pleasant 
balcony on its eastern side and overlook the improvements in that 
direction, but they cannot pass through the grounds. 

Ten steps descend from the roadway to the pavement around the 
basement, which, except immediately at the front of the centre, where 
it is surrounded by a wide area with sodded banks, is everywhere above 
ground. 

There is also a gate on Market street, near the engine house, used for 
bringing in coal or other heavy articles, and another on the eastern side 
of the grounds, for the use of the officers of the hospital only. 

ENGINE HOUSE AND LAUNDRY. 

The engine house, seventy-one feet from the nearest point of the hos- 






331 

pital building, is a substantial stone structure, seventy by sixty-four 
feet, and two stories in height. The character of the ground is such that 
carts drive into the second story to discharge the coal directly into the 
vaults below, and the level of the railroad in the cellar of the hospital 
brings it upon the second floor of the engine house. 

The first story, on the level of the ground on its southern and eastern 
side, contains vaults capable of containing near five hundred tons of 
coal. Adjoining these vaults is the boiler room, thirty by seventeen 
feet, and opening into the engineer's work room, in which will be placed 
lathes, grindstones, pipe cutting machines, etc., driven by the engines 
which are in the engine room, twenty three by nineteen feet in size, and 
separated from the last by a glass partition; while further west, also 
separated by glazed windows and doors, is the fan room, and the tower 
for supplying fresh air to the main duct, which leads from it through 
the entire building. The height of ceiling in this story is seventeen 
feet, and it is arched over the engine room and the engineer's work 
room, so as to give a proper support to the stone floor of the room above. 
In the second story of this building, into which the railroad passes, is 
the wash room, twenty-seven«by twenty-four feet; the room for assort- 
ing and folding clothes, twenty-four by fourteen feet; the mangle room, 
forty -three by eight and a half feet; the drying closet, occupying a space 
twenty-six by thirteen feet; a water closet, and a large room over the 
coal vaults and boilers, surrounded by movable blinds, and intended for 
drying clothes without the use of artificial heat, for making soap, etc. 

The carpenter shop, thirty-six by fifty feet, is of frame, two stories 
high, and forty-five feet from the engine house, from which steam 
may be taken for warming it in the winter. It has two rooms below, 
and a single large one above. 

The carriage house and stables make a neat stone structure, fifty seven 
by thirty-six feet, and two stories high. It has accommodations for six 
horses and as many cows, and the carriages required for the different 
purposes of the institution. The lower floor is of cement, brick, or blue 
stone. The piggery is in the yard in the rear of the stables, and there 
is a carriage yard in front, both being surrounded by a stone wall. 

SIZE OF ROOMS. 

The height of the ceilings throughout the building, and the size of the 
parlors, and of all the rooms in the centre of the building, have been 
already given. The ordinary size of the patients' lodging rooms is nine 
by eleven feet, while there are some in each ward of a much larger size, 
many of which have communicating doors and are intended for patients 
who desire a parlor as well as a chamber, or for those having special 
attendants. The parlors in the first and third wards are thirty -three by 
twenty-four feet, and in the second, fourth, and sixth, they are twenty- 
three by thirty feet. The dining rooms are generally twenty-three by 
seventeen feet. The bath rooms are mostly nine by eleven feet. Six- 
teen rooms in each one-storied building have water closets in them, 
firmly secured, and with a strong downward draught. The sides of 
doors and windows in patients' rooms are generally rounded, by being 
built of brick made expressly for the purpose, and smoothly plastered. 

WINDOWS AND WINDOW GUARDS. 

The windows in patients' rooms are almost universally six feet by 



332 

two feet nine inches, having twenty lights of glass, six by seventeen 
inches in each. In the front wings adjoining the centre, and in the 
third story of the return wings, both sashes are of cast iron, secured in 
wooden frames, so arranged as to balance each other, rising and falling 
only to the extent of five and a half inches, and doing away with the 
necessity for guards. In the other parts of the return wings, and in the 
one-storied buildings, the windows are of the same size, having the 
upper sash of cast iron and immovable, the lower being" of wood, rising 
to its full extent and protected by an ornamental wrought iron guard, 
securely fastened on the outside. A few rooms in each one-story build- 
ing have small windows out of reach of their occupants, and intended 
for the temporary seclusion of very violent or mischievous patients. In 
other parts, as well as in this, wire screens inside of the rooms are occa- 
sionally used to protect glass, and ornamental wire work is adopted in 
some of the parlors, at the ends of corridors and in other similar posi- 
tions, as a guard outside of the windows. 

DOORS. 

The doors throughout are made of the best white pine lumber. In 
the wards they are one and three fourth inches thick, six feet eight 
inches high by two feet seven inches wide. Each door has eight panels 
in it, one of which makes a hinged wicket, and what is commonly 
known as bead and butt, very substantially put together, and wherever 
special strength is required it is obtained by transverse pieces of iron 
let into the wood, or by plates of boiler iron screwed on and painted so 
as to resemble an ordinary door. Each door has a good dead lock to it, 
and occasionally a mortise bolt is added. Over each door is an unglazed 
sash, thirty-one by seventeen inches, covered with fine wire on the 
inside, or a space thirty-one by five inches, which can be filled up at 
pleasure by a tight board or by wire. Lift hinges have been used for 
all these doors, which for patients' lodging rooms always open into the 
corridors. 

FLOORS. 

The floors throughout are of the best yellow pine, cut to order in 
Florida and piled up on the grounds two years before it was used. The 
boards are one inch and a quarter thick, varying in width from two and 
a quarter to four inches, and put down with secret nailing. Counter 
ceiling is everywhere used. The only exception to this kind of flooring 
is in the two kitchens, the scullery, a space in the basement hall in 
front, the bake room, all the sink, water closet, and wash rooms, the 
line between different wards, the entrance to the stairways, and the 
main wash room in the engine house, which are of brown German flag- 
stones laid on brick arches; the engineer's work room, which is paved 
with brick; the front of the boiler room, which is of iron and blue stone 
flagging; and the engine room, one sink room, and all the ward stair- 
ways, which are of slate, admirably adapted to such a purpose, and 
which has also been used extensively for window sills, stairways, and 
other purposes. , 

STAIRWAYS. 

All the stairways in those parts of the building occupied by patients 
are fire proof. The framework is of cast iron, built into the brick work 
on each side and covered with slate, which has many advantages. The 






333 

rise of these steps is only seven inches, and there are platforms every 
five or six steps, with convenient handrails on both sides from top to 
bottom. They are all well lighted by windows by day and by gas at 
night. The well around which the stairs wind is used for hat or coat 
rooms for the different stories. 

PLASTERING. 

The inside plastering is what is called hard finish, composed of lime 
• and sand, without plaster of Paris, except for ceilings, and well trowelled. 
This finish admits of being scrubbed for years without injury, and is at 
all times ready for painting. The outside of the building is rough cast, 
the material used being the pulverized stone of which the house is built 
and lime, to which an agreable shade of color is given by sand. Hy- 
draulic cement is used near the ground in certain positions, in many of 
the sink and wash rooms, in the kitchen and scullery, in the main wash 
room, and as a substitute for the ordinary wash boards in many of the 
ward corridors and patients' chambers. 

. ROOFING. 

The roof is of Pennsylvania slate, fastened on lath, and plastered with 
hair mortar on the under and upper edges, and on the joints of the 
slate. The pitch is one fourth of the span. The water from the roof is 
carried off through four inch cast iron pipes, inside of the building, and 
easily accessible, into large drains leading into the main culvert. 

SEWERAGE. 

The main culvert is two thousand and thirty-two feet in length. It is 
thirty-five inches from top to bottom in the clear, built of brick laid in 
hydraulic cement, egg-shaped, the smaller part being at the bottom. 
Beginning near the intersection of the north return wing and one-storied 
buildings, at which point it receives various pipes from the adjacent 
wards, it passes under the main chimney, by the engine house and barn, 
and extends to Mill Creek, into which it discharges just before it reaches 
Market street. Through this culvert all the drainage from the building 
and much of the grounds is carried off, being intersected by branch 
culverts at various points in its course. 

BATH ROOMS, WATER CLOSETS, ETC. 

There are twenty-one bath rooms and as many water closets in the 
building, in addition to those in the patients' rooms. Sixteen are in the 
wards. Each bath room has in it a cast iron bath tub, covered with 
zinc paint, and with improved arrangements for the admission and dis- 
charge of water through the bottom. In addition to the ordinary hot 
air flue, there is a coil of steam pipe for direct radiation in each, go that 
when hot baths are used the temperature of the room may be made so 
high as to prevent the sensation of chilliness when coming from the 
water. The water pipes in these rooms are generally of galvanized iron, 
left exposed, so as to be readily accessible, and passing from story to 
story through castings made for the purpose, so that in case of leakage 
the ceilings may not be injured. 

The water closets are of cast iron, enameled, have no traps, but are 



334 

open, so as to have a constant downward draught of air through them 
into the main chimney, as have all the sinks, bath tubs, etc., in the whole 
establishment. The water is let on by the opening of the door. 

The wash basins in the wash rooms are of marble, with strong swing 
cocks. The sinks are of cast iron, and have hot and cold water at each. 
There is also an iron hopper to each, and into which the slops, etc., are 
emptied. There are permanent fixtures for securing the towels in each 
wash room. The drying closets are sufficiently large to contain a bed, 
and like the closets for buckets, etc., have flues leading into and from 
them, and thus secure a direct communication with the, fan below and 
the ventilating ducts above. All these arrangements in each ward are 
clustered together, and have scarcely any wood in any part to absorb 
moisture or retain unpleasant odors. 

SUPPLY OF WATER. 

The new hospital is suplied with water from a well twenty-five feet 
in diameter, containing fifty thousand gallons, and into which, as meas- 
ured at the dryest period of the last year, is a daily flow of thirty thou- 
sand gallons of excellent water. There is also a constant stream of 
spring water passing near the well, which can at any time be turned 
into it. By means of one of Worthington's combined direct acting 
steam pumps, capable of raising ten thousand gallons per hour, this 
water is forced through seven hundred and eight feet of six inch cast 
iron pipe into the four boiler iron tanks in the dome, and from which it is 
distributed through the entire building. These tanks are one hundred 
and three feet above the well, and contain twenty-one thousand gallons. 
They are so arranged that one or all may be used at pleasure; have 
overflows and pipes through which they may have the sediment washed 
out whenever deemed desirable. The elevation of these tanks is suffi- 
cient to secure the feeding of the steam boilers when carrying a pressure 
of forty pounds to the inch. These tanks were made at the works and 
put in place before the roof was on the building. It is intended that 
they shall always be about full of water, and a small pipe leading from 
thein to the engine house tells the engineer on duty when that is the case. 
There is also in the engine room a single Worthington steam pump, capa- 
ble of raising five thousand gallons per hour, and intended to prevent 
any possible deficiency of water should an accident hajypen to the larger 
engine. The rule is that both should be used some part of every day, 
so that in case of emergency there may never be a doubt of their being 
in working order. 

The tank for supplying the centre building with hot water is twelve 
feet in length and twenty-three inches in diameter, and is placed above 
the cooking range, the heat being supplied through circulating pipe from a 
waterback behind one of the range tires, and is abundant for all purposes. 
The supply of hot water for the wards is derived from six iron tanks 
placed in the most convenient points in the cellar, in which situations 
they are easily accessible, and leakages can do little injury to the build- 
ing. The heat is derived from steam coils coming from the summer 
pipe (as it is called) used for cooking and all other purposes except 
warming the building. The large steam boilers at the engine house are 
supplied with hot water by the condensed steam used in heating, which 
ordinarily returns to them by gravity, but when it does not is received 
into an iron tank and forced into them by a small steam pump. The 
laundry has hot water from a large tank placed in the oven, which 



335 

covers the boilers, and through which the exhaust steam from the 
engines and pumps can be made to pass whenever desired, and which 
may be also used for feeding the large boilers. There are three wells of 
excellent water besides, at convenient points near the building, and 
which supplied all the water required in its erection. A fourth is now 
'being sunk near the stable. 

LIGHTING. 

The hospital is lighted by gas from the city works. The fine meter 
is placed in the engine room, and a record is made every morning of the 
consumption during the preceding night. Stopcocks are placed at con- 
venient points for checking the flow of gas through the main pipes, and 
the ordinary kinds of fixtures have been adopted throughout the build- 
ing. The gas is also used for experimental purposes in the lecture 
room, and for boiling water, etc., in the medical office. 

FURNITURE. 

The furniture is intended to be neat and plain, but of a comfortable 
and substantial character; the amount in the various apartments being 
in a great measure depen4ent on the character of the patients occupying 
them. Carpets of some kind generally cover the parlors, and some por- 
tions of the corridors and chambers. Wardrobes, tables, mirrors, and 
other conveniences are frequently added to the bedsteads, which are of 
various kinds, mostly of wood, but many are of wrought or cast iron, 
painted of a light color, a few of which last are secured to the floor. 

HEATING AND VENTILATION. 

There is no fire used in any part of the hospital for heating, although 
provision for open fires has been made in all the parlors and in many of 
the other large rooms, should such an arrangement ever be deemed 
desirable. The only fires kept up in the building are those in the 
kitchens, bake and ironing rooms. 

In the boiler room at the engine house there are three large tubular 
boilers. Each of these has a furnace five feet three inches wide by five 
feet three inches long and seven feet four inches high. The shell is 
seventeen feet eight inches long by four feet six inches in diameter. 
Combustion chamber four feet long, and ninety-eight tubes two and 
a half inches in diameter and eleven feet long. The total heating sur- 
face for each is seven hundred and forty-four square feet. The grate 
surface is twenty and a quarter square feet. The escaping' gases enter 
a common flue, and the draft can be regulated by a clamper at the back 
end of each boiler, or the supply of air graduated by a register in the 
ashpit door. 

These boilers furnish steam for warming the entire hospital, and for 
driving all the machinery, pumping water, for ventilation, washing, 
cooking, etc. They are so arranged that one or all may be used at 
pleasure, either for heating or driving the machinery. The steam is 
carried from them in a five-inch welded iron pipe, and after reaching 
the hospital building, it is distributed in eighty-three air chambers, 
placed in its cellar, with direct flues leading from them to the apartments 
above. The gases from the boiler fires pass through an underground 
flue, four feet wide and six feet high, a distance of five hundred and 



336 

fifty-seven feet, rising thirty-one feet in its course, till it comes to the 
foot of the main chimney, which is seventy-eight feet above the surface 
of the ground. The chimney is built double, the interior being round, 
formed of hard brick, without pargeting, six feet in diameter in the clear 
from bottom to top, the latter being formed of cast iron, while the foun- 
dation is of pointed stone work to a height of eleven feet, and the re- 
mainder of pressed brick. The underground flue alluded to contains 
the main steampipe until it reaches the nearest point of the building, 
and also that portion of it which is carried to the north section of the 
hospital, and is immediately over the main culvert. This chimney is 
made the ventilating power for securing a strong downward draft of air 
through all the water closets, urinals, sinks, and bath tubs in the entire 
establishment, and for this reason is placed in a central position on the 
eastern side of the building. The coils for heating are composed of 
welded iron pipes, three quarters or one inch in diameter, and are in 
two sections in all the air chambers, so that one or both may be used, 
according to the severity of the weather. 

In the engine room are two horizontal high pressure steam engines 
of fine finish. They are exactly alike, each having a cylinder ten inches 
in diameter and a stroke of twenty-four inches. They are so arranged 
that either may be substituted for the other, and one may be made to do 
the work of both in case of emergency. Ordinarily, one drives the fan, 
and is therefore a part of the ventilating apparatus, while the second 
drives all the other machinery. The fan is of cast iron, its extreme 
diameter being sixteen feet and its greatest width four feet. It is driven 
directly from the shaft of the engine, and its revolutions vary from 
thirty to sixty per minute, according to the requirements of the house. 
The fresh air is received from a tower forty feet high, so that all surface 
exhalations are avoided, and is then driven through a duct, which at its 
commencement is eight and one half by ten and one half feet, into the 
extreme parts of the building. From the cold air duct openings lead 
into the different warm air chambers, which in the one storied buildings 
are covered with slate; but in all other parts of the hospital these 
chambers and air ducts are arched with brick laid with smooth joints. 
The warm air in nearly all cases is admitted near the floor and the ven- 
tilators open near the ceiling always in the interior walls. The only 
exception to this arrangement is in the one storied buildings, in which, 
in the patients' rooms, the warm air is admitted above and the venti- 
lators are taken off near the floor. All the ventilating flues terminate 
in the attic in close ducts, either of brick or wood, smoothly plastered, 
increasing in size about thirty per cent more rapidly than the capacity 
of the flues entering them, and by which, through the different belvi- 
deres on the roof, they communicate with the external atmosphere. In 
the centre building the ventilation is through the main dome. There is 
no leaden pipe used in the building. 

COOKING AND DISTRIBUTION OF FOOD. 

All the cooking is done in the central kitchen, which has in it a large 
range with two fires and three ovens, a rotary roaster, a double iron 
steamer containing ninety gallons, a smaller one — iron outside and cop- 
per tinned on the inside — containing forty-five gallons, and six of tin for 
vegetables, besides the vessels for tea and coffee. The food prepared in 
this room is put into closed tin boxes, which are lowered by a dumb 
waiter to the car standing on the track of the railroad, where it passes 



337 

under the kitchen, and is thus conveyed to the bottom of the various 
dumb waiters which lead directly to the different dining rooms above, of 
which, as before remarked, there is one for each ward. Each dining 
room has a steam table with carving dishes on it, and abundant provis- 
ion for keeping meats and vegetables warm as long as may be desired. 
The dumb waiters are all controlled by the person having charge of the 
railroad; they are moved by a crank and wheel, and wire rope is substi- 
tuted for that commonly adopted. The railroad is an indispensable part 
of the arrangements for distributing food. By its use a meal may be 
delivered in all the ward dining rooms (eight in numbex) on one side — 
the extreme ones being five hundred and eighty feet distant — in ten 
minutes after leaving the kitchen, or for the whole sixteen in twenty 
minutes. It also forms a very convenient mode of transporting articles 
from one section of the building to another, carrying clothing to and 
from the laundry, and gives a protected passageway in going from the 
centre building to the engine house, barn, and workshop, and for persons 
visiting their friends in the room set apart for the purpose between the 
sixth and seventh wards. 

PROVISION AGAINST FIRE. 

As already mentioned, no fires are required in the building for warm- 
ing it, and gas is used for lighting. Wherever one wing comes in con- 
tact with another, or with the centre building, all the openings in the 
walls, which extend up through the slate roof, have iron doors in addi- 
tion to the ordinary wooden ones, and which may be closed at pleasure. 
The floors of the kitchen and bakeroom, in which alone fire is used, are 
of German flagstone laid on brick arches, and all the stairways in the 
wings are fireproof. It is intended that there should always be about 
twenty thousand gallons of water in the tanks in the dome of the centre 
building, and fifteen thousand gallons per hour may be placed there by 
the pumping engines. A standpipe connected with this reservoir passes 
into every story and into every w^ird, in all of which it is intended to 
have a piece of hempen hose constantly attached, so that by simply 
turning a stopcock water may be put on a fire almost as soon as discov- 
ered. A steam pipe also passes up into the attic of each wing, and as 
one of the large boilers is constantly fired up, steam may at any moment 
be let into the building by simply turning a valve in the cellar. Hose is 
also kept near the steam pumps, so that it may be promptly attached 
and water thrown on the barn, carpenter shop, engine house, and 
contiguous parts of the hospital. A watchman is constantly passing 
through the house at night, and by means of two of Harris' watch- 
clocks, as made by H. B. Ames of New York, there is no difficulty in 
ascertaining not only how often each ward is visited, but almost the 
' moment the visit was made, and of course the time taken in passing 
from one ward to another. 

LAUNDRY ARRANGEMENTS. 

The clothing, bedding, etc., collected in the different wards, after being 
sent to the cellar, are conveyed from that point by the railroad to the 
room for assorting clothes in the engine house, and thence into the large 
wash room, in which, besides the usual washing, rinsing, and blue tubs 

43 



338 

and soap vat, is one of the valuable Shaker washing machines, in which 
six different kinds of clothes can be washed at the same time, and a cen- 
trifugal wringer, both of which are driven by one of the steam engines. 
From the wringer the washed articles are taken to the drying closet, in 
which by means of the heat derived from the exhaust steam from the 
engines passing through a large amount of cast iron pipe, and fresh air 
from the fan, they are in a very few minutes made ready for the mangle 
(also driven by steam power), or folded and taken by the railroad to the 
ironing room near the centre building, to which they are raised by the 
dumb waiter already referred to, or are sent directly to the principal 
clothes room, from which they are distributed by the same route as they 
may be required in the wards. All the divisions of the washing machine, 
of the rinsing and washing tubs, have hot and cold water and steam 
introduced directly into them, and the water from them all is carried off 
under the stone floor of the room to one of the iron columns below, 
through which it passes into the culvert on the outside of the building. 

PLEASURE GROUNDS, GARDENS, AND YARDS. 

This new hospital is situated in the midst of its pleasure grounds, 
embracing about fifty acres, and from most parts of which are fine views 
of the surrounding cduntry; the boundary wall being so arranged, from 
the natural character of the ground, or made so by excavations, that 
little of it can be seen from any part of the building that is occupied by 
patients. There are two pleasant grows of natural forest trees within 
the inclosure, and several hundred others, evergreen and deciduous, that 
have already been planted or collected for the purpose, will give an 
ample amount of shaded drives and walks. A carriage road has already 
been made on the inside of the wall throughout its extent, and winding 
by the gardens and terraces around the buildings will ultimately be two 
miles long. The foot walks are not to be less extensive, and the brick 
pavements about the building have been already mentioned. There are 
also, as may be remembered, three pleasant yards on each side of the 
building, and connected directly with the adjacent wards. The vegeta- 
ble garden will contain about eight acres, and is in full view from the 
north side of the building. Flower borders have been made near to and 
around the entire structure. The only fences inside of the inclosure are 
to give privacy to the patients in the yards, or to prevent those walking 
about the grounds from approaching certain parts of the building. 

COST. 

Without a statement of the cost, no account of such a building and 
such arrangements as have been described would be at all complete, and 
especially not of one like that under notice, which is entirely the offspring 
of the benevolence and liberality of a community, a result of practical 
Christianity, and a generous recognition of the paramount claims which 
such afflictions of our fellow men have at all times upon our interests 
and our sympathies. The style of architecture is plain, and all useless 
ornament has been studiously dispensed with; but whenever the comfort 
and welfare of the patient were concerned, everything has been done in 
a thorough manner. 

The amount of money paid on account of the new building and its 
varied fixtures and arrangements, up to the present time, is three hun- 
dred and twenty-two thousand five hundred and forty-two dollars and 



339 

eighty-six cents, and a farther sum of about thirty thousand dollars will 
be required to meet the other liabilities that have been incurred. Of 
this total sum, twenty thousand two hundred and seventy-six dollars and 
twenty-eight cents have been for the boundary wall and gate house; 
two thousand two hundred and forty-one dollars and forty-six cents for 
the carriage house and stabling; eight hundred dollars for the carpenter 
shop; four thousand four hundred and fifty-six dollars and three cents 
for machinery of different kinds; twenty-three thousand six hundred and 
twelve dollars and thirty-seven cents for heating and ventilating appa- 
ratus; fifteen thousand two hundred and one dollars and forty-seven 
cents for grading, for building, planting, and improving the grounds; 
and ten thousand four hundred and forty-one dollars and seventy-three 
cents for furniture. 



PLANTS, DESCEIPTIONS AKD ESTIMATES OF THE BOSTON 
HOSPITAL FOE THE INSANE AT WINTHEOP. 

Boston Lunatic Hospital, | 

Boston (Mass.), September 28, 1867. } 

To the Board of Directors for Public Institutions: 

Gentlemen: Three months ago the committee on the proposed new 
"Hospital for the Insane " referred the "plans" to the architect (N. J. 
Bradlee, Esq.) and myself, with the request that we would give them a 
thorough revision. That has been done and the result is before you. 

While not doubting that experts of larger experience may discover 
defects and suggest improvements, we are at a loss to see how, without 
great expense, the plans can easily be materially improved. 

Such a hospital structure, containing no provision that can well be 
dispensed with, and requiring not a dollar for mere ornamentation, will 
be no discredit to the humanity, intelligence, and good taste of Boston. 
These plans have my hearty and unqualified approval. 

Yery respectfully, 

CLEMENT A. WALKEE, 

Superintendent. 



CONSTRUCTION OF THE BUILDING. 

The exterior walls will be of brick, with granite trimmings, sur- 
mounted by a brick cornice and French roof. 

The grouping of the several wings, falling back as they do from the 
centre and from each other, with their several projections and bays, will 
give a very pleasing effect to the whole. 

BASEMENT. 

This story, which will be from four to six feet above the level of the 
ground, will contain five hundred and four hot air chambers, each being 
two feet by five feet, for the pipes to heat the building. The basement 



340 

of the rear centre building will contain store rooms and vegetable 
cellars. 

PRINCIPAL STORY. 

The general plan of the building consists of a centre building, three 
stories high, sixty feet by ninety-two feet, a building in the rear of the 
centre, two stories high, forty-nine feet by one hundred and fifty-six 
feet, and two wings of three sections each, two being three stories high. 
The first section on each side is fifty-six feet by one hundred and fifty- 
four feet; the second section, fifty-six by one hundred and forty-five feet 
nine inches; the third section, two stories high, fifty-seven feet by one 
hundred and twenty-one feet nine inches; one being at each side of and 
at an angle of forty-five degrees to the second section. This gives eight 
distinct wards for each sex, the minimum required (by unanimous vote 
of the Association of Medical Superintendents of American Institutions 
for the Insane) in a hospital for two hundred patients; this designed for 
three hundred. 

The principal story of the centre building contains Superintendent's 
room, twenty feet square; private room, seventeen feet by twenty feet; 
Assistant Superintendent's room, seventeen feet by. twenty feet; apoth- 
ecary's room, twelve feet by seventeen feet; library, twelve feet by 
seventeen feet; dining room, twenty feet by forty feet; pantry, seven- 
teen feet by twenty feet; and six large closets. 

The rear centre building will contain: reception rooms, twelve feet by 
eighteen feet; attendants' dining room, eighteen feet by forty feet; store 
room, eighteen feet by twenty-six feet; kitchen, twenty feet by forty- 
two feet; laundry, twenty feet by forty feet; ironing room, twenty-two 
feet square; pantry, six feet by fifteen feet; bakery, fourteen feet square; 
bread closet, seven feet by twenty-three feet; tin closet, six feet by 
fifteen feet; oven, ten feet by twelve feet; drying room, ten feet by eigh- 
teen feet. 

The first section on each side of the centre will contain fifteen single 
rooms, eight feet six inches by fourteen feet; sitting room, twenty -two 
feet by thirty feet; bay window, eighteen feet by twenty feet; reception 
room, thirteen feet by twenty-one feet; attendants' room, thirteen feet 
by twenty-one feet; bath room, nine feet by fourteen feet; storeroom, 
nine feet by fourteen feet; dormitory, seventeen feet by twenty-seven 
feet; dining room, sixteen feet by thirty-four feet. 

The second section on each side will contain sixteen single rooms; 
general store room, twenty feet by twenty-three feet; the other rooms 
are the same as described for first section. 

The third section will contain twelve single rooms, eight feet six 
inches by fourteen feet; open corridor, twenty-eight feet by sixty-two 
feet; dining room, seventeen feet by twenty feet; storeroom, ten feet by 
seventeen feet; attendants' room, fourteen feet by seventeen feet; bath 
room, ten feet by seventeen feet. 

SECOND STORY. 

The second and third stories of the first and second sections are 
divided the same as the first story of said buildings, and the second 
story of the third section is also like the first story of the same. The 
attics of the first and second sections will furnish pleasant and desirable 
infirmaries. The attics of the third section will afibrd ample and con- 
venient room for the isolation of small pox and other contagious diseases. 



341 

The second and third stories of the centre building are arranged to 
accommodate the Superintendent and his family, with his assistants. 

The second story of the rear centre building contains a chapel, forty-five 
feet by seventy -five feet; domestics' room, fourteen feet by twenty feet; 
billiard room, eighteen feet by forty-five feet; storeroom, twelve feet by 
twenty feet. The main centre building and the first section on each 
side, also rear centre buildings, are connected by corridors ten feet wide. 

THE ENGINE HOUSE 

Is located one hundred and three feet distant from the rear centre 
building, and is forty-seven feet by seventy -four feet, containing a boiler 
room thirteen feet by fifty-seven feet; engine room, fourteen feet by 
twenty-four feet; fan blower room, thirty-two feet by fourteen feet; 
fuel rooms, fourteen feet by twenty-three feet, and fourteen feet by 
thirty-four feet; connected with this house is the large chimney, fifteen 
feet square at the base by one hundred and eighty feet in height. 

CONSTRUCTION. 

The outside cellar walls are to be two feet thick of stone laid in 
cement mortar; the walls above are of brick twenty inches thick, laid 
hollow, the outer walls being twelve inches, an air space of four inches, 
and the inner wall four inches thick. _ The interior walls on the side 
corridors will be also twenty inches thick, so as to leave room for the 
ventilating and heating flues to pass through them. To render the 
building as nearly fireproof as possible without going to the exj)ense of 
brick arches and iron beams or girders, all the plastering will be done 
directly upon the brick walls without furring; the floors will be plas- 
tered between the floor boards and the base or plinth around the rooms, 
and corridors will be of face brick, painted; all the inside partitions 
will be also of brick. 

To give some idea of the size of the building, it may be stated that it 
will require one thousand seven hundred and seventy-five perches of 
stone for the foundation. Seven million seven hundred and fifty thou- 
sand two hundred and fifty bricks will be used in the walls; sixty-two 
thousand eight hundred and twenty-nine yards of plastering; three 
thousand two hundred and twenty-four feet of gutters, with two thou- 
sand twenty-two feet of conductors; eighteen thousand two hundred 
and fifty feet of gas pipe; one million two hundred and eighty-nine 
thousand four hundred and eighty-eight feet of lumber; one thousand 
two hundred and thirty-eight windows; fifty-nine thousand four hundred 
and twenty-four lights of glass, and nine hundred eighty-nine doors; 
five hundred and four being required for the pipe chambers in the base- 
ment. 

HEATING AND VENTILATION. 

The building will be arranged so as to hereafter decide upon the best 
method of heating, whether by hot water, high or low pressure steam, 
all of which systems have their strenuous advocates. The ventilation 
of all the waterclosets will be effected by the downward draft to the 
heated chimney; the ventilation of the wards will be likewise arranged 
for the downward draft; there will also be provided in the boiler house, 
a fan blower upon the Doctor Nichols plan, to be used as occasion may 
require. 



342 

The high chimney will be so constructed as to form a large ventilating 
flue entirely around the boiler flue, to assure a steady draft. The under- 
ground air flues will be eight feet in diameter, diminishing in size as 
they approach the third section, with small branches to each of the 
several hot air chambers in the basement story. 






COUNTY OF SUBBEY ADDITIONAL LUNATIC ASYLUM. 

At JBrookwood, near Woking. 

The additional asylum for the pauper lunatics of the County of Surrey 
is designed to accommodate six hundred and fifty patients, and stands 
on an estate of about one hundred and fifty acres in extent, at Brook- 
wood, about three miles from the "Woking station on the South Western 
Bailway. 

The site is bounded on the south by the BasiDgstoke Canal, and on the 
east and west by the high roads to Guildford and Chertsey. Few sites 
could be found in the country better adapted for such an institution. 
The soil, a primary consideration, is a dry sand, with occasional veins of 
gravel, loam, and clay. The ground rises gradually from the south and 
west about seventy feet above the level of the canal, and the buildings 
are erected on a plateau of some extent, with a fine range of views and 
southern aspect. 

The plan of the building gives to every part uninterrupted views of 
the surrounding country, and free access to light and air. 

The principal entrance with the visiting Justices', Superintendent's, 
Forter's, Steward's, and waiting. rooms form the central portion of the 
north front of the main building. 

To the west of the entrance block is the laundry wing, with the rooms 
for the female working patients and their attendants. 

On the east side of the entrance block corresponding to the laundry 
wing just described, are the workshops and the apartments appropriated 
to the patients engaged in them. 

In the centre are placed the kitchen, offices and stores, so arranged 
that the service on the male side is perfectly separated from the female 
side. 

The apartments for the Assistant Surgeon and the matron, with dis- 
pensary and stores, are grouped together in the centre of the south 
building, near the wards for recent cases, which with the infirmaries 
form the rest of the south front of main building. 

The height of the rooms occupied by the patients on the ground floor 
is twelve feet, and .on the upper floors eleven feet. 

Fifty superficial feet, or nearly six hundred cubic feet, are allowed to 
each patient in all dormitories, except those in the infirmaries, where the 
cubical contents exceed seven hundred feet per patient. 

The smallest separate sleeping room is nine feet by seven feet, which 
gives seven hundred cubic feet; in the infirmaries they vary from eleven 
feet by eight feet seven inches to fourteen feet by ten feet. 

The day rooms, exce]3t one on each side of the wards for recent and 
acute case, are all on the ground floor. 



e 



343 

Lavatories, water closets, baths, slop rooms, store rooms, and closets 
are provided in all the wards. • 

To the east and west of the main building are placed detached blocks 
with associated day rooms and dormitories for the accommodation of 
ninety patients in each building. These blocks are connected with the 
main building by covered passages. 

The buildings are constructed in stock brickwork, relieved with a. few 
coloured brick dressings and sailing courses. 

The stairs are of stone in all parts occupied by the patients, with the 
well holes built up. 

The floors of all day and sleeping rooms and of the south corridors 
and corridors in infirmary wings are boarded. 

The sashes generally are of wood, double hung with locks and keys, 
to prevent their being opened beyond a certain height. 

The doors to all patients' rooms have solid panels, and all angles are 
rounded. 

The day rooms and corridors have open fireplaces, in which are warm 
air grates, so constructed that warm air is admitted either into the room 
with the fireplace, or conducted to the chamber above. Provision has 
been made for the introduction of warm water pipes in case any auxiliary 
heating power should be required. 

In both day rooms and dormitories ventilating flues for the extraction 
of foul air are formed, having sectional areas, in proportion to the sizes 
of the rooms, connected with the towers by large air shafts formed in 
the roofs. 

The sewage is conveyed from water closets, sinks, etc., by means of 
pipe drains to filtering tanks, so placed and constructed as to permit of 
the distribution by gravity of the filtered water over a considerable por- 
tion of the land under cultivation. 

The Superintendent's house is a detatched building placed to the 
southwest of the main building, near the boundary of the airing grounds 
for the female patients. Plans of the floors of this house are given, and 
show with sufficient clearness the arrangement and accommodation 
provided. 

The house for the gardener, in which accommodation has been pro- 
vided for twelve of the more quiet patients, is situated in the east of the 
main building, about two hundred yards from the entrance to male 
airing grounds, and near the kitchen garden. 

The farm bailiff's house, in which accommodation has also been pro- 
vided for twelve patients, adjoins the farm buildings. 

The gas works are placed to the northwest of the main building about 
sixty-five yards from the laundry block. 

The chapel is a detached building, designed to accommodate three 
hundred and forty-three persons, very simply constructed, with plain 
gothic headed windows and doors. Ventilating dormers are provided in 
the roof, and the building is heated by Haden & Son's apparatus. There 
is a chancel with vestry to the north. From the entrance of main build- 
ing to the south porch of chapel the distance is about two hundred 
yards. 

The detailed statement of the accommodation provided for the patients 
in the several parts of the building is as follows, namely: 

RECENT CASES. 

Female side — Ground floor: Single rooms, eight. First floor: Single 



344 

rooms, eight; dormitories, twelve. Second floor: Dormitories, forty- 
five. Total, seventy -three. 

Male side — Ground floor: Single rooms, eight. First floor: Single 
rooms, eight; dormitories, twelve. Second floor: Dormitories, forty- 
five. Total, seventy-three. 

INFIRMARY. 

Female side — Ground floor: Dormitory, six; single rooms, three. 
First floor: Dormitories, twenty-four; single rooms, four. Second floor: 
Dormitories, thirty-four. Total, seventy-one. 

Male side — Ground floor: Dormitory, six; single rooms, three. First 
floor: Dormitories, twenty-four; single rooms, four. Second floor: Dor- 
mitories, thirty-four. Total, seventy-one. 

SOUTH FRONT. 

Female side — Second floor: Dormitories, thirty-two. 
Male side — Second floor: Dormitories, twenty-two. 

NORTH FRONT. 

Female side — First floor: Dormitories, twenty -five. Second floor: 
Dormitories, twenty. Total, forty-five. 

Male side — First floor: Dormitories, five* Second floor: Dormitories, 
eighteen. Total, twenty-three. 

LAUNDRY BLOCK. 

First floor: Dormitories, sixteen; single rooms, two. Total, eighteen. 

WORKSHOP BLOCK. 

First floor: Dormitories, sixteen; single rooms, two. Total, eighteen. 

DETACHED BLOCKS. 



FEMALE SIDE. 




MALE SIDE. 




Ground Floor. 
Dormitories 


20 
2 

68 


Ground Floor. 
Dormitories 


20 


Single rooms 


Single rooms 


2 


First Floor. 
Dormitories 


First Floor. 


68 




Total 




Total 


90 


90 












845 

SUMMARY OF TOTALS. 



Recent cases 73 

Infirmary 71 

South front 32 

North front 45 

Laundry block 18 

Detached block 90 

Total 329 



Recent cases , 73 

Infirmary 71 

South front 22 

North front 23 

Workshop block 18 

Detached block 18 

Bailiff's house 12 

Gardener's house 12 

Total 321 



\ 



The buildings, with all the necessary work and fittings having been 
completed, the institution was opened in the Summer of eighteen hundred 
and sixty-seven. 

The cost of the buildings, exclusive of fittings, and engineer's and 
gas works, amounted to the sum of sixty-one thousand nine hundred 
po uj i d s ster 1 i n g . 

C. H. HOWELL. Architect. 



ERRATA. 

Page thirteen, tenth line from bottom, for " eleven " read " seven." 

Page forty-seven, nineteenth line from bottom, for " excess " read " sexes." 

Page tifty, fifth line of second paragraph, for " courses " read " causes." 

Page eighty-eight, ninth lkie from top, for "seventeenth " read "nineteenth." 

The tables of " Kesults of Treatment," on pages two hundred and five, two hundred and 

six, and two hundred and seven, should come immediately after " Kesults of Treatment." 

on page two hundred and two. 

Page sixty-four, first column figures, fifth line, for "260,247 " read " 560,247." 






PI. 1. 



4 



so. 



wsnw Mmwmm mm wm 



USUI 



>M<& 



Appendix V.— l'l, [ 




JuirraSi; 



WARD BUILDINGS 

SO. Hot Air Chambers | 31. Railroad 
32. Serving /looms. 



Nath'l J Bradlee. Arch't. 



CE 


nnf 


UILIMNUS 


Hull. 
. Corridor 

Silling Rooms 
. Store-Rooms 

P.i, itry 

Kitchen 




\i j:f Laundry. 
| '.'5. Dri/ing «.ir» 
l 81. Railroad. 
J 82. Serving Boo 

I 33. Workshop. 

I I 84 CeKar. 



BOARD OF DIRECTORS FOR 185)7 



36. Medical Stores 



Moses Kimball, 
J. Putnam Bradlee, 
Jonas Fitch, 
Amos A. Duimels, 
Franeis 0. Manning, 
tlenrv A. Drake. 



jfclvnnus A. Denic 
Avery Plnmcr, 
William Cumston, 
Clms. S. liuigess. 
Lewis Rice, 
Sam'l W. Hodges. 

.1 Putnam Bkai 



President- 



William Willmt, Olerk. 



SL'fEKl.NTKNOLKT Of HOSPITAL 

Clement A. WaUtir M. D. 






p 
p 
p 

p 

T 

six, 

on ] 

P 



: F.— Pi. 2. 




1. Hall. 

2. Gon-ido 

3. Bay Wi 

4. Sitting-i 

5. RecCptit 

6. Attendu 



f 



FIRST STORY. 



Appendix P. pi, 2 







ENRINt HOUSi. 

i|S- S:^"»' 28. Fan Room 

36. Chimney. 



WARD BUILDINGS. 



1. Hall. 

2. Corridor. 

3. .Spy Window. 
*. Sitting-Room. 

5. Reception Room. 

6. dttentfttnts' Room. 



7. Dining Room. 

8. Patients' Room. 

9. Dormitory. 

10. Store-Room. 

11. Rath-Room. 

12. Water Closet- 



Niith'l J. Bradlec. Aren't. 



in 




BOARD OF DIRECTORS FOR I86T. 



Moses Kimball. 
J. Putnam Briuilee 
.Jonas Fitch, 
Amos A. Dunncls, 
I'm Dels C. Manning 
Henry A. Drake 



William Willktt, Clerk. 



S.vlvanns A. DeDio, 
Avery Plumer, 
William Cumston, 
Chas. S. Burgess, 
Lewis Rice, 
Sam'l W. Hodges. 

Putnam Bkadlbk, President. 



CENTRE BUILDINGS 

1. Hall. 

2. Corridor. 
5. Reception Room. 
7. Dining Room. 

10. Store-Room. 

12. Water-Closet. 

13. Supfs Room. 
U. Ass't Supt'l Room 
16. Apothecary's. 



16. Library. 

17. Pantry. 

18. A'itcften. 
111. Bakery. 

20. Bread Closet. 

21. 7Y)i CTosef. 

22. Oven. 

23. Laundry. 

24. Ironing Room. 



Drying Room. 



SUPK«INTKM>K:<T OF HOSPITAL: 

Clement A. Walker, M. D. 






six 
on 






Appendix F. — PI. 3- 





T jfasTfTTIIJTTTT^E 



,AN OF THE PENNSYLVANIA HOSPITAL FOR THE INSANE. 

DEPARTMENT FOR MALE8. 



4 



313 

(511 






f.PiA. 



Tl 



Appendix F.Pl. 4 




WARDS TOR MALE PATIENTS, 



WARCS PaH FEMALE PATIENTS. 



MICHIGAN ASYLUM FOR THE INSANE, KALAMAZOO. 



SI J 

on 



iP:F - ri;.r> 











ACCOMMODATION 

h Vmnlt; Sul r 

Hnria ( iixftit /"? 

//!/;>;/ ,nrv 71 

Sim ih /-rmi/ :t:> 

Ahrf/t MmiJ f.i 

Ifiiwrtry/J/tJiA- IS 

1)rfrlr/irr/ /HrJC/t •'■"' 

/„/,,/ :;■!<> 



GKOl'XD PLAN. 



on 



.F -PL. 6. 



OF SIJRR1 



LUNATIC 



et to the Incli 




COUNTY OF SURREY. 

NEW COUNTY LUNATIC ASYLUM. 

Scale 40 feet to the Inch 



AP.F- IM..C). 




SIS 

on 






i 



TTSm?I 



rrric 



Je 40 I 



AP.F- PL. 7 







AP.F- l'L.7 




ft 



COUNTY OF SFRREY 

:nt:w county lunatic asylum 

Scale 40 feel to the Inch.. 



> 




♦ % 






o 



WJ 



m 



PLAN OF SECOND FLOOR. 



S13 

on 




I 



.r.PL.8 



-r 



K 



t 






(;lamokoax 
county asy1um 



ACCOMMODATES 365 PAUPER PATIENTS 



Wards. 

1 . Day Rooms. 

1*. Dormitories. 

2 . Single Rooms. 

3 . Attendant's Rooms. 

4 . Store Room. 

5 . Batb Rooms. 

6 . Dressing Rooms. 

7 . Lavatories. 

8 . ScullerieB. 

9 . Padded Room. 

10 . Head Attendant's Rooms. 

Central Public Rooms. 

11 . Surgery. 

12 . Medical Superintendent's Room. 

13 . Entrance to Med. Superintendent's House. 

14 . Visiting Room. 

15 . Porter's Room. 

16 . [in trance to Assistant Med. Officer's Rooms. 

17 . Chaplain's Room and Library. 
IS. Committee Room. 

19 . Do. Retiring Room. 

Economic Department, Officers, etc. 
L t0. Kitchen. 
^ 5 S 

21 . BeaUwy. 

22 . Dining Hall. 

23 . Attendant's Malt. 

24 . Kitchen Stores. 

25 . Kitchen Yard. 
2B . Steward's Stores. 

27 . Steward's Office. 

28 . Housekeeper's Store und Cutting out Room. 

29 . Wood and Coals. 

30 . Dead House. 




AP.I.PL.8. 

COST ABOUT % 77,700 




Detached Buildings and Yard. 

Medical Superintendent's House. 

Steward's House. 

Housekeeper's Rooms & Rooms for Domestic Servants. 

Laundry Block with Ward attached, 

a . Sorting and Receiving Room. 

b. Washing- House. 

C . Do. for Foul Linen. 

d . Drying Ground. 

6 . Drying Closet. 

f , Ironing Room. 
. Workshop Block with Ward attached. 

a.a . Tailor's and Shoemaker's. 

b.b . Mattress Makers. 

C.C . Carpenter's. 

d.d. Painter's. 

e.e . Yard for Workshops. 
. Engineer's Yard, including Engine House, 

Plumber's and Smith's Shops, Gasworks, 

Steam and Hot Water Boilers, Steam Engine and Well. 
. Stable Yard with Shed, 
i . Do. Med. Superintendent. 
. Church. 

; . Entrance Lodge. 
. , Female Airing Courts. 
H. Male Airing Courts. 
i. Kitchen Garden. 



sis 
on 



m fm9m .,. iWWBHI 




A]>. F._ 1M. 9. 



w r 



3 



rORES. LAVATORIES, ETC., ETC 




J 



* 




^1 



r 

i : 




PLAN OF FIRST FLOOR. 

OCCUPIED ENTIRELY BY SLEEPING, ACCOMMODATION AND THE NECESSARY CLOTHES STORES. LAVATORIES. ETC., ETC.. 



-M223 





: 



l./.J 



Reference 

|». Dormitories. 

2. Single Rooms. 

3. Attendants. 
'4. Stores. 

5. Bath. 

10. Head Attendant's /.'cow.*. 

16. Assistant Medical Officer's Rooms. 

A. Medical Superintendent's House. 

B. Steward's House. 

C. Housekeeper and Domestic Servants 
F. Engineer's Bous*. 




AP F. PI. 10. 



whim. 



*--■£. 





Perth District Lunatic Asylum. 




. 



si: 
on 



^-~-"\ 



4 



EMTT 

\S9 E 














LUNATIC ASYLUM. 

MEEBENBERG, NEAR HAARLEM. 
Ground Plan and Elevation. 



a 




AP. F -PL. II 




irOTziZE 




si: 

on 






P.F.PL.12 



ASYLU 

NEAR HAARLEM 



first Stoxv 



2 



Z4 



^w^ * * 



2* 



Z-'A 2.3 S* 



h i. ■■ w II ■ II J 



3 



, f I 



rn m 
|-iiia E^i^fflSL riE 



LUNATIC ASYLUM. 

Meerenberg, near haaiu.km 
Plan of fixe first Story 



AP.F. PL. 12. 




: !L. 



ITTOATIC ASYLUM IN VIENNA. 

GKOXT3TD 1'LAaV . 










fl 



(: 







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\ 





II. 

its. 
Iff. 



ss: 



de, 

<0> 












ilium. Znlnk, I. Piaidtvilrir XV I'll lid. 



Fig '.' 




EXPLANATION OF TABLE NUMBEE TWO. 

Figure 1. 

Plan of situation. Parterre and first story of Institution. 



I. Building of administration. 



II. Section of quiet patients. III. 
Section of less quiet patients. IY. Section of idiotic (unclean) patients. 
Y. Section of raving patients. YI. Church. YI. Household building. 
YIII. Coach room. IX. Ice cellar. 



a. 
b. 
c. 
d. 
e. 
f 

9- 
h. 

1. 

2. 
3. 

4. 

5. 

6. 

7. 

8. 

9. 
10. 
11. 
12. 
13. 



Day room; 

Kitchen for dishwashing; 

Eoom of attendants; 

Sleeping apartment, third class; 

Isolating room; 

Eoom, first class; 

Eoom, second class; 

Garderobe room; 

Announcing room; 

Yisiting room; 

Medical office; 

Medical office; 

Store room for material; 

Eoom of the office porter; 

Dispensary; 

Eoom of the porter; 

Sleeping room of the porter; 

Office of the Administration; 

Magazines ; 

Lodgings of Assistant Physic'n: 

Eoom of accountant; 



i. Depot room ; 

k. Eoom for somatic patients ; 

I. Cell; 

m. Drying room; 

n. Bath room, third class; 

o. Dressing room; 

p. Bath room, first and sec'nd class; 

q. Single bath room. 

14. Sewing room (on the other side, 

lodgings of kitchen servants) ; 

15. Kitchen for cooking; 

16. Adjoining rooms thereof; 
16' Formerly provisory kitchen; 

17. Kitchen for washing; 

18. Adjoining rooms thereof; 

19. Eoom for washing machines; 

20. Eoom for steam boiler; 

21. Engine room; 

22. Eoom of machinists; 

23. Yentilation tower. 






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